WorldWideScience

Sample records for providing usual care

  1. Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use.

    Science.gov (United States)

    Jones, Audrey L; Cochran, Susan D; Leibowitz, Arleen; Wells, Kenneth B; Kominski, Gerald; Mays, Vickie M

    2015-12-01

    The benefits of the patient-centered medical home (PCMH) over and above that of a usual source of medical care have yet to be determined, particularly for adults with mental health disorders. To examine qualities of a usual provider that align with PCMH goals of access, comprehensiveness, and patient-centered care, and to determine whether PCMH qualities in a usual provider are associated with the use of mental health services (MHS). Using national data from the Medical Expenditure Panel Survey, we conducted a lagged cross-sectional study of MHS use subsequent to participant reports of psychological distress and usual provider and practice characteristics. A total of 2,358 adults, aged 18-64 years, met the criteria for serious psychological distress and reported on their usual provider and practice characteristics. We defined "usual provider" as a primary care provider/practice, and "PCMH provider" as a usual provider that delivered accessible, comprehensive, patient-centered care as determined by patient self-reporting. The dependent variable, MHS, included self-reported mental health visits to a primary care provider or mental health specialist, counseling, and psychiatric medication treatment over a period of 1 year. Participants with a usual provider were significantly more likely than those with no usual provider to have experienced a primary care mental health visit (marginal effect [ME] = 8.5, 95 % CI = 3.2-13.8) and to have received psychiatric medication (ME = 15.5, 95 % CI = 9.4-21.5). Participants with a PCMH were additionally more likely than those with no usual provider to visit a mental health specialist (ME = 7.6, 95 % CI = 0.7-14.4) and receive mental health counseling (ME = 8.5, 95 % CI = 1.5-15.6). Among those who reported having had any type of mental health visit, participants with a PCMH were more likely to have received mental health counseling than those with only a usual provider (ME = 10.0, 95 % CI

  2. Costs of terminal patients who receive palliative care or usual care in different hospital wards.

    Science.gov (United States)

    Simoens, Steven; Kutten, Betty; Keirse, Emmanuel; Berghe, Paul Vanden; Beguin, Claire; Desmedt, Marianne; Deveugele, Myriam; Léonard, Christian; Paulus, Dominique; Menten, Johan

    2010-11-01

    In addition to the effectiveness of hospital care models for terminal patients, policy makers and health care payers are concerned about their costs. This study aims to measure the hospital costs of treating terminal patients in Belgium from the health care payer perspective. Also, this study compares the costs of palliative and usual care in different types of hospital wards. A multicenter, retrospective cohort study compared costs of palliative care with usual care in acute hospital wards and with care in palliative care units. The study enrolled terminal patients from a representative sample of hospitals. Health care costs included fixed hospital costs and charges relating to medical fees, pharmacy and other charges. Data sources consisted of hospital accountancy data and invoice data. Six hospitals participated in the study, generating a total of 146 patients. The findings showed that palliative care in a palliative care unit was more expensive than palliative care in an acute ward due to higher staffing levels in palliative care units. Palliative care in an acute ward is cheaper than usual care in an acute ward. This study suggests that palliative care models in acute wards need to be supported because such care models appear to be less expensive than usual care and because such care models are likely to better reflect the needs of terminal patients. This finding emphasizes the importance of the timely recognition of the need for palliative care in terminal patients treated in acute wards.

  3. Telephone versus usual care in management of acute whiplash ...

    African Journals Online (AJOL)

    Whiplash associated disorder (WAD) is a common and costly condition, and recommended management includes advice to “act as usual” and exercise. Providing this treatment through a telephonic intervention may help to improve access to care, and reduce costs. This pilot study assessed: (1) the effectiveness of a ...

  4. The feasibility of a pragmatic randomised controlled trial to compare usual care with usual care plus individualised homeopathy, in children requiring secondary care for asthma.

    Science.gov (United States)

    Thompson, E A; Shaw, A; Nichol, J; Hollinghurst, S; Henderson, A J; Thompson, T; Sharp, D

    2011-07-01

    To test the feasibility of a pragmatic trial design with economic evaluation and nested qualitative study, comparing usual care (UC) with UC plus individualised homeopathy, in children requiring secondary care for asthma. This included recruitment and retention, acceptability of outcome measures patients' and health professionals' views and experiences and a power calculation for a definitive trial. In a pragmatic parallel group randomised controlled trial (RCT) design, children on step 2 or above of the British Thoracic Society Asthma Guidelines (BTG) were randomly allocated to UC or UC plus a five visit package of homeopathic care (HC). Outcome measures included the Juniper Asthma Control Questionnaire, Quality of Life Questionnaire and a resource use questionnaire. Qualitative interviews were used to gain families' and health professionals' views and experiences. 226 children were identified from hospital clinics and related patient databases. 67 showed an interest in participating, 39 children were randomised, 18 to HC and 21 to UC. Evidence in favour of adjunctive homeopathic treatment was lacking. Economic evaluation suggests that the cost of additional consultations was not offset by the reduced cost of homeopathic remedies and the lower use of primary care by children in the homeopathic group. Qualitative data gave insights into the differing perspectives of families and health care professionals within the research process. A future study using this design is not feasible, further investigation of a potential role for homeopathy in asthma management might be better conducted in primary care with children with less severe asthma. Copyright © 2011 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved.

  5. Manual acupuncture plus usual care versus usual care alone in the treatment of endometriosis-related chronic pelvic pain: study protocol for a randomised controlled feasibility study.

    Science.gov (United States)

    Armour, Mike; Smith, Caroline A; Schabrun, Siobhan; Steiner, Genevieve Z; Zhu, Xiaoshu; Lawson, Kenny; Song, Jing

    2018-01-01

    Endometriosis is the most common cause of chronic pelvic pain worldwide. Non-surgical treatments are effective for only 30-50% of women and have a significant side effect burden that leads to high discontinuation rates. Surgery can be effective but is expensive and invasive, and symptoms tend to recur within 5 years. There is early evidence that acupuncture may be effective in treating endometriosis-related chronic pelvic pain, showing clinically significant analgesia. Both levels of inflammation and pain processing have been shown to be altered in women with chronic pelvic pain. Acupuncture has been shown to reduce inflammation and change central pain processing in other conditions, but research on women with endometriosis is currently lacking. The aim of this feasibility study is to provide data on recruitment rates, retention, appropriateness of outcome measures, minimal clinically important difference in numeric rated scales for pain and the potential effect of acupuncture on pain processing and markers of inflammation in endometriosis-related CPP. We will include women aged 18-45 years with a diagnosis of endometriosis via laparoscopy in the past 5 years. A total of 30 participants will be recruited and randomly allocated in a 1:1 ratio to receive acupuncture or usual care. Women in the acupuncture group will receive two 45-min treatment sessions per week for 8 weeks (total of 16 sessions). Women in the usual care group will continue with their current treatment regimen. The primary feasibility outcomes are recruitment rates, retention rates and the safety and acceptability of the intervention; secondary patient-centred outcomes include a change in 0-10 daily pelvic pain ratings, the Endometriosis Health Profile 30 (EHP-30) and changes in conditioned pain modulation, resting and task-related EEG activity and inflammatory markers. Analyses will be performed blind to group allocation. This is a two-armed, assessor blind, randomised controlled feasibility

  6. A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain

    Science.gov (United States)

    Cherkin, Daniel C.; Sherman, Karen J.; Avins, Andrew L.; Erro, Janet H.; Ichikawa, Laura; Barlow, William E.; Delaney, Kristin; Hawkes, Rene; Hamilton, Luisa; Pressman, Alice; Khalsa, Partap S.; Deyo, Richard A.

    2009-01-01

    Background Acupuncture is a popular complementary and alternative treatment for chronic back pain. Recent European trials suggest similar short-term benefits from real and sham acupuncture needling. This trial addresses the importance of needle placement and skin penetration in eliciting acupuncture effects for patients with chronic low back pain. Methods 638 adults with chronic mechanical low back pain were randomized to: individualized acupuncture, standardized acupuncture, simulated acupuncture, or usual care. Ten treatments were provided over 7 weeks by experienced acupuncturists. The primary outcomes were back-related dysfunction (Roland Disability score, range: 0 to 23) and symptom bothersomeness (0 to 10 scale). Outcomes were assessed at baseline and after 8, 26 and 52 weeks. Results At 8 weeks, mean dysfunction scores for the individualized, standardized, and simulated acupuncture groups improved by 4.4, 4.5, and 4.4 points, respectively, compared with 2.1 points for those receiving usual care (P0.05). Conclusions Although acupuncture was found effective for chronic low back pain, tailoring needling sites to each patient and penetration of the skin appear to be unimportant in eliciting therapeutic benefits. These findings raise questions about acupuncture’s purported mechanisms of action. It remains unclear whether acupuncture, or our simulated method of acupuncture, provide physiologically important stimulation or represent placebo or non-specific effects. PMID:19433697

  7. Parent and child usual source of care and children's receipt of health care services.

    Science.gov (United States)

    DeVoe, Jennifer E; Tillotson, Carrie J; Wallace, Lorraine S; Angier, Heather; Carlson, Matthew J; Gold, Rachel

    2011-01-01

    PURPOSE In the United States, children who have a usual source of care (USC) have better access to health care than those who do not, but little is known about how parental USC affects children's access. We examined the association between child and parent USC patterns and children's access to health care services. METHODS We undertook a secondary analysis of nationally representative, cross-sectional data from children participating in the 2002-2007 Medical Expenditure Panel Survey (n = 56,302). We assessed 10 outcome measures: insurance coverage gaps, no doctor visits in the past year, less than yearly dental visits, unmet medical and prescription needs, delayed care, problems getting care, and unmet preventive counseling needs regarding healthy eating, regular exercise, car safety devices, and bicycle helmets. RESULTS Among children, 78.6% had a USC and at least 1 parent with a USC, whereas 12.4% had a USC but no parent USC. Children with a USC but no parent USC had a higher likelihood of several unmet needs, including an insurance coverage gap (adjusted risk ratio [aRR] 1.33; 95% confidence interval [CI], 1.21-1.47), an unmet medical or prescription need (aRR 1.70; 95% CI 1.09-2.65), and no yearly dental visits (aRR 1.12; 95% CI 1.06-1.18), compared with children with a USC whose parent(s) had a USC. CONCLUSIONS Among children with a USC, having no parent USC was associated with a higher likelihood of reporting unmet needs when compared with children whose parent(s) had a USC. Policy reforms should ensure access to a USC for all family members.

  8. PRECISE - pregabalin in addition to usual care for sciatica: study protocol for a randomised controlled trial.

    Science.gov (United States)

    Mathieson, Stephanie; Maher, Christopher G; McLachlan, Andrew J; Latimer, Jane; Koes, Bart W; Hancock, Mark J; Harris, Ian; Day, Richard O; Pik, Justin; Jan, Stephen; Billot, Laurent; Lin, Chung-Wei Christine

    2013-07-11

    Sciatica is a type of neuropathic pain that is characterised by pain radiating into the leg. It is often accompanied by low back pain and neurological deficits in the lower limb. While this condition may cause significant suffering for the individual, the lack of evidence supporting effective treatments for sciatica makes clinical management difficult. Our objectives are to determine the efficacy of pregabalin on reducing leg pain intensity and its cost-effectiveness in patients with sciatica. PRECISE is a prospectively registered, double-blind, randomised placebo-controlled trial of pregabalin compared to placebo, in addition to usual care. Inclusion criteria include moderate to severe leg pain below the knee with evidence of nerve root/spinal nerve involvement. Participants will be randomised to receive either pregabalin with usual care (n = 102) or placebo with usual care (n = 102) for 8 weeks. The medicine dosage will be titrated up to the participant's optimal dose, to a maximum 600 mg per day. Follow up consultations will monitor individual progress, tolerability and adverse events. Usual care, if deemed appropriate by the study doctor, may include a referral for physical or manual therapy and/or prescription of analgesic medication. Participants, doctors and researchers collecting participant data will be blinded to treatment allocation. Participants will be assessed at baseline and at weeks 2, 4, 8, 12, 26 and 52. The primary outcome will determine the efficacy of pregabalin in reducing leg pain intensity. Secondary outcomes will include back pain intensity, disability and quality of life. Data analysis will be blinded and by intention-to-treat. A parallel economic evaluation will be conducted from health sector and societal perspectives. This study will establish the efficacy of pregabalin in reducing leg pain intensity in patients with sciatica and provide important information regarding the effect of pregabalin treatment on disability and quality of life

  9. Babesiosis for Health Care Providers

    Centers for Disease Control (CDC) Podcasts

    2012-04-25

    This podcast will educate health care providers on diagnosing babesiosis and providing patients at risk with tick bite prevention messages.  Created: 4/25/2012 by Center for Global Health, Division of Parasitic Diseases and Malaria.   Date Released: 4/25/2012.

  10. Dancing for Parkinson Disease: A Randomized Trial of Irish Set Dancing Compared With Usual Care.

    Science.gov (United States)

    Shanahan, Joanne; Morris, Meg E; Bhriain, Orfhlaith Ni; Volpe, Daniele; Lynch, Tim; Clifford, Amanda M

    2017-09-01

    To examine the feasibility of a randomized controlled study design and to explore the benefits of a set dancing intervention compared with usual care. Randomized controlled design, with participants randomized to Irish set dance classes or a usual care group. Community based. Individuals with idiopathic Parkinson disease (PD) (N=90). The dance group attended a 1.5-hour dancing class each week for 10 weeks and undertook a home dance program for 20 minutes, 3 times per week. The usual care group continued with their usual care and daily activities. The primary outcome was feasibility, determined by recruitment rates, success of randomization and allocation procedures, attrition, adherence, safety, willingness of participants to be randomized, resource availability, and cost. Secondary outcomes were motor function (motor section of the Unified Parkinson's Disease Rating Scale), quality of life (Parkinson's Disease Questionnaire-39), functional endurance (6-min walk test), and balance (mini-BESTest). Ninety participants were randomized (45 per group). There were no adverse effects or resource constraints. Although adherence to the dancing program was 93.5%, there was >40% attrition in each group. Postintervention, the dance group had greater nonsignificant gains in quality of life than the usual care group. There was a meaningful deterioration in endurance in the usual care group. There were no meaningful changes in other outcomes. The exit questionnaire showed participants enjoyed the classes and would like to continue participation. For people with mild to moderately severe PD, set dancing is feasible and enjoyable and may improve quality of life. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  11. Cardiac rehabilitation versus usual care for patients treated with catheter ablation for atrial fibrillation

    DEFF Research Database (Denmark)

    Risom, Signe S; Zwisler, Ann-Dorthe; Rasmussen, Trine Bernholdt

    2016-01-01

    ) versus 20.7mL kg(-1) min(-1), p of main effect=0.003, p of interaction between time and intervention=0.020). No significant difference between groups on Short Form-36 was found (53.8 versus 51.9 points, P=.20). Two serious adverse events (atrial fibrillation in relation to physical exercise and death...... unrelated to rehabilitation) occurred in the cardiac rehabilitation group versus one in the usual care group (death unrelated to intervention) (P=.56). In the cardiac rehabilitation group 16 patients versus 7 in the usual care group reported non-serious adverse events (P=.047). CONCLUSION: Comprehensive...

  12. Integrating a Smartphone-Based Self-Management System into Usual Care of Advanced CKD.

    Science.gov (United States)

    Ong, Stephanie W; Jassal, Sarbjit V; Miller, Judith A; Porter, Eveline C; Cafazzo, Joseph A; Seto, Emily; Thorpe, Kevin E; Logan, Alexander G

    2016-06-06

    Patient self-management has been shown to improve health outcomes. We developed a smartphone-based system to boost self-care by patients with CKD and integrated its use into usual CKD care. We determined its acceptability and examined changes in several clinical parameters. We recruited patients with stage 4 or 5 CKD attending outpatient renal clinics who responded to a general information newsletter about this 6-month proof-of-principle study. The smartphone application targeted four behavioral elements: monitoring BP, medication management, symptom assessment, and tracking laboratory results. Prebuilt customizable algorithms provided real-time personalized patient feedback and alerts to providers when predefined treatment thresholds were crossed or critical changes occurred. Those who died or started RRT within the first 2 months were replaced. Only participants followed for 6 months after recruitment were included in assessing changes in clinical measures. In total, 47 patients (26 men; mean age =59 years old; 33% were ≥65 years old) were enrolled; 60% had never used a smartphone. User adherence was high (>80% performed ≥80% of recommended assessments) and sustained. The mean reductions in home BP readings between baseline and exit were statistically significant (systolic BP, -3.4 mmHg; 95% confidence interval, -5.0 to -1.8 and diastolic BP, -2.1 mmHg; 95% confidence interval, -2.9 to -1.2); 27% with normal clinic BP readings had newly identified masked hypertension. One hundred twenty-seven medication discrepancies were identified; 59% were medication errors that required an intervention to prevent harm. In exit interviews, patients indicated feeling more confident and in control of their condition; clinicians perceived patients to be better informed and more engaged. Integrating a smartphone-based self-management system into usual care of patients with advanced CKD proved feasible and acceptable, and it appeared to be clinically useful. The results provide

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

    Directory of Open Access Journals (Sweden)

    Stefanie Leistner

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

  14. Implementation of the Tobacco Tactics intervention versus usual care in Trinity Health community hospitals

    Directory of Open Access Journals (Sweden)

    Sonia A. Duffy

    2016-11-01

    Full Text Available Abstract Background Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM implementation framework, a National Institutes of Health-sponsored study compared the nurse-administered Tobacco Tactics intervention to usual care. A prior paper describes the effectiveness of the Tobacco Tactics intervention. This subsequent paper provides data describing the remaining constructs of the RE-AIM framework. Methods This pragmatic study used a mixed methods, quasi-experimental design in five Michigan community hospitals of which three received the nurse-administered Tobacco Tactics intervention and two received usual care. Nurses and patients were surveyed pre- and post-intervention. Measures included reach (patient participation rates, characteristics, and receipt of services, adoption (nurse participation rates and characteristics, implementation (pre-to post-training changes in nurses' attitudes, delivery of services, barriers to implementation, opinions about training, documentation of services, and numbers of volunteer follow-up phone calls, and maintenance (continuation of the intervention once the study ended. Results Reach: Patient participation rates were 71.5 %. Compared to no change in the control sites, there were significant pre- to post-intervention increases in self-reported receipt of print materials in the intervention hospitals (n = 1370, p < 0.001. Adoption: In the intervention hospitals, all targeted units and several non-targeted units participated; 76.0 % (n = 1028 of targeted nurses and 317 additional staff participated in the training, and 92.4 % were extremely or somewhat satisfied with the training. Implementation: Nurses in the intervention hospitals reported increases in providing advice to quit, counseling, medications, handouts, and DVD (all p < 0.05 and reported decreased barriers to implementing smoking cessation services (p < 0.001. Qualitative comments were very

  15. Effects of Structured Versus Usual Care on Renal Endpoint in Type 2 Diabetes: The SURE Study

    Science.gov (United States)

    Chan, Juliana C.; So, Wing-Yee; Yeung, Chun-Yip; Ko, Gary T.; Lau, Ip-Tim; Tsang, Man-Wo; Lau, Kam-Piu; Siu, Sing-Chung; Li, June K.; Yeung, Vincent T.; Leung, Wilson Y.; Tong, Peter C.

    2009-01-01

    OBJECTIVE Multifaceted care has been shown to reduce mortality and complications in type 2 diabetes. We hypothesized that structured care would reduce renal complications in type 2 diabetes. RESEARCH DESIGN AND METHODS A total of 205 Chinese type 2 diabetic patients from nine public hospitals who had plasma creatinine levels of 150–350 μmol/l were randomly assigned to receive structured care (n = 104) or usual care (n = 101) for 2 years. The structured care group was managed according to a prespecified protocol with the following treatment goals: blood pressure triglyceride 500 μmol/l or dialysis). RESULTS Of these 205 patients (mean ± SD age 65 ± 7.2 years; disease duration 14 ± 7.9 years), the structured care group achieved better control than the usual care group (diastolic blood pressure 68 ± 12 vs. 71 ± 12 mmHg, respectively, P = 0.02; A1C 7.3 ± 1.3 vs. 8.0 ± 1.6%, P structured care (23.1%, n = 24) and usual care (23.8%, n = 24; NS) groups had similar end points, but more patients in the structured care group attained ≥3 treatment goals (61%, n = 63, vs. 28%, n = 28; P < 0.001). Patients who attained ≥3 treatment targets (n = 91) had reduced risk of the primary end point (14 vs. 34; relative risk 0.43 [95% CI 0.21–0.86] compared with that of those who attained ≤2 targets (n = 114). CONCLUSIONS Attainment of multiple treatment targets reduced the renal end point and death in type 2 diabetes. In addition to protocol, audits and feedback are needed to improve outcomes. PMID:19460913

  16. Motivational, reduction and usual care interventions for smokers who are not ready to quit: a randomized controlled trial.

    Science.gov (United States)

    Klemperer, Elias M; Hughes, John R; Solomon, Laura J; Callas, Peter W; Fingar, James R

    2017-01-01

    To test whether, in comparison to usual care, brief motivational or reduction interventions increase quit attempts (QA) or abstinence among smokers who are not ready to quit. A parallel-group randomized controlled trial of brief motivational (n = 185), reduction (n = 186) or usual care (n = 189) telephone interventions delivered over the course of 4 weeks. Outcomes were assessed at 6- and 12-month follow-ups. No medication was provided. United States. A total of 560 adult smokers of ≥ 10 cigarettes per day who were not ready to quit in the next 30 days. The primary outcomes were whether participants made a QA that lasted ≥ 24 hours and whether they made a QA of any length between baseline and 6 months. Secondary outcomes included 7-day point-prevalence abstinence at 6 and 12 months. The 12-month follow-up was added after the study began. A priori-defined comparisons were between motivational versus usual care and reduction versus usual care conditions. The probability of making a QA that lasted ≥ 24 hours was not significantly different between the motivational (38%) or the reduction (31%) conditions and the usual care (34%) condition [motivational versus usual care odds ratio (OR) = 1.19, 95% confidence interval (CI) = 0.78-1.82; reduction versus usual care OR = 0.89, 95% CI = 0.57-1.36]. Bayes factors ranged from 0.13 to 0.18. Findings regarding a QA of any length were similar. At 6 months, the motivational condition had marginally more abstinence than usual care (11 versus 5%, OR = 2.17, 95% CI = 0.99-4.77), but the reduction condition was not significantly different from usual care (8 versus 5%, OR = 1.57, 95% CI = 0.69-3.59). At 12 months, the motivational condition had significantly more abstinence than usual care (10 versus 4%, OR = 2.80, 95% CI = 1.14-6.88) and the reduction condition had marginally more abstinence than usual care (9 versus 4%, OR = 2.45, 95% CI = 0.98-6.09). Among adult smokers who are not ready

  17. Podiatry intervention versus usual care to prevent falls in care homes: pilot randomised controlled trial (the PIRFECT study).

    Science.gov (United States)

    Wylie, Gavin; Menz, Hylton B; McFarlane, Sarah; Ogston, Simon; Sullivan, Frank; Williams, Brian; Young, Zoe; Morris, Jacqui

    2017-07-12

    Common foot problems are independent risk factors for falls in older people. There is evidence that podiatry can prevent falls in community-dwelling populations. The feasibility of implementing a podiatry intervention and trial in the care home population is unknown. To inform a potential future definitive trial, we performed a pilot randomised controlled trial to assess: (i) the feasibility of a trial of a podiatry intervention to reduce care home falls, and (ii) the potential direction and magnitude of the effect of the intervention in terms of number of falls in care home residents. Informed by Medical Research Council guidance on developing and evaluating complex interventions, we conducted a single blind, pilot randomised controlled trial in six care homes in the East of Scotland. Participants were randomised to either: (i) a three month podiatry intervention comprising core podiatry care, foot and ankle exercises, orthoses and footwear provision or (ii) usual care. Falls-related outcomes (number of falls, time to first fall) and feasibility-related outcomes (recruitment, retention, adherence, data collection rates) were collected. Secondary outcomes included: generic health status, balance, mobility, falls efficacy, and ankle joint strength. 474 care home residents were screened. 43 (9.1%) participants were recruited: 23 to the intervention, 20 to control. Nine (21%) participants were lost to follow-up due to declining health or death. It was feasible to deliver the trial elements in the care home setting. 35% of participants completed the exercise programme. 48% reported using the orthoses 'all or most of the time'. Completion rates of the outcome measures were between 93% and 100%. No adverse events were reported. At the nine month follow-up period, the intervention group per-person fall rate was 0.77 falls vs. 0.83 falls in the control group. A podiatry intervention to reduce falls can be delivered to care home residents within a pilot randomised

  18. Skin care education and individual counselling versus treatment as usual in healthcare workers with hand eczema

    DEFF Research Database (Denmark)

    Ibler, K.S.; Jemec, G.B.E.; Thomsen, S.F.

    2012-01-01

    Objective: To evaluate the effect of a secondary prevention programme with education on skin care and individual counselling versus treatment as usual in healthcare workers with hand eczema. Design: Randomised, observer blinded parallel group superiority clinical trial. Setting: Three hospitals...... in Denmark. Participants: 255 healthcare workers with self reported hand eczema within the past year randomised centrally and stratified by profession, severity of eczema, and hospital. 123 were allocated to the intervention group and 132 to the control group. Interventions: Education in skin care...

  19. Acupuncture, Counseling, and Usual care for Depression (ACUDep: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    MacPherson Hugh

    2012-11-01

    Full Text Available Abstract Background The evidence on the effect of acupuncture or counseling for depression is not conclusive yet is sufficient to warrant further research. Our aim is to conduct a full-scale RCT to determine the clinical and cost effectiveness of acupuncture and counseling compared to usual care alone. We will explore the experiences and perspectives of patients and practitioners. Methods/Design Randomized controlled trial with three parallel arms: acupuncture plus usual care, counseling plus usual care, and usual care alone, in conjunction with a nested qualitative study using in-depth interviews with purposive samples of trial participants. Participants: Patients aged over 18 years diagnosed with depression or mood disorder by their GP and with a score of 20 or above on the Beck Depression Inventory (BDI-II. Randomization: Computer randomization by York Trials Unit to acupuncture, counseling, and usual care alone in proportions of 2:2:1, respectively, with secure allocation concealment. Interventions: Patients allocated to acupuncture and counseling groups receive the offer of up to 12 weekly sessions. Both interventions allow flexibility to address patient variation, yet are constrained within defined protocols. Acupuncture is based on traditional Chinese medicine and counseling is non-directive within the humanistic tradition. Outcome: The PHQ-9 is the primary outcome measure, collected at baseline, 3, 6, 9, and 12 months. Also measured is BDI-II, SF-36 Bodily pain subscale, and EQ-5D. Texted mood scores are collected weekly over the first 15 weeks. Health-related resource use is collected over 12 months. Analysis: The sample size target was for 640 participants, calculated for an effect size of 0.32 on the PHQ-9 when comparing acupuncture with counseling given 90% power, 5% significance, and 20% loss to follow-up. Analysis of covariance will be used on an intention-to-treat basis. Thematic analysis will be used for qualitative data. We will

  20. Electronic Health Record for Intensive Care based on Usual Windows Based Software.

    Science.gov (United States)

    Reper, Arnaud; Reper, Pascal

    2015-08-01

    In Intensive Care Units, the amount of data to be processed for patients care, the turn over of the patients, the necessity for reliability and for review processes indicate the use of Patient Data Management Systems (PDMS) and electronic health records (EHR). To respond to the needs of an Intensive Care Unit and not to be locked with proprietary software, we developed an EHR based on usual software and components. The software was designed as a client-server architecture running on the Windows operating system and powered by the access data base system. The client software was developed using Visual Basic interface library. The application offers to the users the following functions: medical notes captures, observations and treatments, nursing charts with administration of medications, scoring systems for classification, and possibilities to encode medical activities for billing processes. Since his deployment in September 2004, the EHR was used to care more than five thousands patients with the expected software reliability and facilitated data management and review processes. Communications with other medical software were not developed from the start, and are realized by the use of basic functionalities communication engine. Further upgrade of the system will include multi-platform support, use of typed language with static analysis, and configurable interface. The developed system based on usual software components was able to respond to the medical needs of the local ICU environment. The use of Windows for development allowed us to customize the software to the preexisting organization and contributed to the acceptability of the whole system.

  1. Youth Psychotherapy Change Trajectories and Outcomes in Usual Care: Community Mental Health versus Managed Care Settings

    Science.gov (United States)

    Warren, Jared S.; Nelson, Philip L.; Mondragon, Sasha A.; Baldwin, Scott A.; Burlingame, Gary M.

    2010-01-01

    Objective: The authors compared symptom change trajectories and treatment outcome categories in children and adolescents receiving routine outpatient mental health services in a public community mental health system and a private managed care organization. Method: Archival longitudinal outcome data from parents completing the Youth Outcome…

  2. Health Care Provider Value Chain

    OpenAIRE

    Kawczynski , Lukasz; Taisch , Marco

    2009-01-01

    International audience; In every society there is a need for an efficient health care system. This paper aims to propose a value definition and a value chain model within the health care. In order to define value patients and experts were surveyed. The proposed definition offers a complex way of looking at the value within the health care sector. The proposal of the value chain model is anticipated with a value stream mapping activities and experts interviews. Proposed model offers consistent...

  3. A medical home versus temporary housing: the importance of a stable usual source of care.

    Science.gov (United States)

    DeVoe, Jennifer E; Saultz, John W; Krois, Lisa; Tillotson, Carrie J

    2009-11-01

    Little is known about how the stability of a usual source of care (USC) affects access to care. We examined the prevalence of USC changes among low-income children and how these changes were associated with unmet health care need. We conducted a cross-sectional survey of Oregon's food stamp program in 2005. We analyzed primary data from 2681 surveys and then weighted results to 84087 families, adjusting for oversampling and nonresponse. We then ascertained the percentage of children in the Oregon population who had ever changed a USC for insurance reasons, which characteristics were associated with USC change, and how USC change was associated with unmet need. We also conducted a posthoc analysis of data from the Medical Expenditure Panel Survey to confirm similarities between the Oregon sample and a comparable national sample. Children without a USC in the Oregon population had greater odds of reporting an unmet health care need than those with a USC. This pattern was similar in national estimates. Among the Oregon sample, 23% had changed their USC because of insurance reasons, and 10% had no current USC. Compared with children with a stable USC, children who had changed their USC had greater odds of reporting unmet medical need, unmet prescription need, delayed care, unmet dental need, and unmet counseling need. This study highlights the importance of ensuring stability with a USC. Moving low-income children into new medical homes could disturb existing USC relationships, thereby merely creating "temporary housing."

  4. Trajectories of At-Homeness and Health in Usual Care and Small House Nursing Homes

    Science.gov (United States)

    Molony, Sheila L.; Evans, Lois K.; Jeon, Sangchoon; Rabig, Judith; Straka, Leslie A.

    2011-01-01

    Background: Long-term care providers across the United States are building innovative environments called "Green House" or small-house nursing homes that weave humanistic person-centered philosophies into clinical care, organizational policies, and built environments. Purpose: To compare and contrast trajectories of at-homeness and health over…

  5. Supervised progressive cross-continuum strength training compared with usual care in older medical patients

    DEFF Research Database (Denmark)

    Pedersen, Mette Merete; Petersen, Janne; Beyer, Nina

    2016-01-01

    Background: Hospitalization in older adults is characterized by physical inactivity and a risk of losing function and independence. Systematic strength training can improve muscle strength and functional performance in older adults. Few studies have examined the effect of a program initiated during...... hospitalization and continued after discharge. We conducted a feasibility study prior to this trial and found a progression model for loaded sit-to-stands feasible in older medical patients. This study aims to determine whether a simple supervised strength training program for the lower extremities (based...... on the model), combined with post-training protein supplementation initiated during hospitalization and continued at home for 4 weeks, is superior to usual care on change in mobility 4 weeks after discharge in older medical patients. Methods: Eighty older medical patients (65 years or older) acutely admitted...

  6. Remission and rheumatoid arthritis: Data on patients receiving usual care in twenty-four countries

    DEFF Research Database (Denmark)

    Sokka, Tuulikki; Hetland, Merete Lund; Mäkinen, Heidi

    2008-01-01

    and lowest remission rates was >/=15% in 10 countries, 5-14% in 7 countries, and definition of remission, male sex, higher education, shorter disease duration, smaller number of comorbidities, and regular......OBJECTIVE: To compare the performance of different definitions of remission in a large multinational cross-sectional cohort of patients with rheumatoid arthritis (RA). METHODS: The Questionnaires in Standard Monitoring of Patients with RA (QUEST-RA) database, which (as of January 2008) included 5......,848 patients receiving usual care at 67 sites in 24 countries, was used for this study. Patients were clinically assessed by rheumatologists and completed a 4-page self-report questionnaire. The database was analyzed according to the following definitions of remission: American College of Rheumatology (ACR...

  7. Remission and rheumatoid arthritis: Data on patients receiving usual care in twenty-four countries

    DEFF Research Database (Denmark)

    Sokka, Tuulikki; Hetland, Merete Lund; Mäkinen, Heidi

    2008-01-01

    and lowest remission rates was >/=15% in 10 countries, 5-14% in 7 countries, and generally low remission rates [definition of remission, male sex, higher education, shorter disease duration, smaller number of comorbidities, and regular......OBJECTIVE: To compare the performance of different definitions of remission in a large multinational cross-sectional cohort of patients with rheumatoid arthritis (RA). METHODS: The Questionnaires in Standard Monitoring of Patients with RA (QUEST-RA) database, which (as of January 2008) included 5......,848 patients receiving usual care at 67 sites in 24 countries, was used for this study. Patients were clinically assessed by rheumatologists and completed a 4-page self-report questionnaire. The database was analyzed according to the following definitions of remission: American College of Rheumatology (ACR...

  8. Costs and financial benefits of video communication compared to usual care at home: a systematic review.

    NARCIS (Netherlands)

    Peeters, J.M.; Mistiaen, P.; Francke, A.L.

    2011-01-01

    We conducted a systematic review of video communication in home care to provide insight into the ratio between the costs and financial benefits (i.e. cost savings). Four databases (PUBMED, EMBASE, COCHRANE LIBRARY, CINAHL) were searched for studies on video communication for patients living at home

  9. Preventive Dental Checkups and Their Association With Access to Usual Source of Care Among Rural and Urban Adult Residents.

    Science.gov (United States)

    Khan, Aishah; Thapa, Janani R; Zhang, Donglan

    2017-09-01

    This study aimed to assess the relationship between rural or urban residence and having a usual source of care (USC), and the utilization of preventive dental checkups among adults. Cross-sectional analysis was conducted using data from the Medical Expenditure Panel Survey 2012. We performed a logit regression on the relationship between rural and urban residence, having a USC, and having at least 1 dental checkup in the past year, adjusting for sociodemographic characteristics and health status. After controlling for covariates, rural adult residents had significantly lower odds of having at least 1 dental checkup per year compared to their urban counterparts (odds ratio [OR] = 0.73, 95% confidence interval [CI]: 0.62-0.86, P rural and urban residents, having a USC was significantly associated with an 11% (95% CI = 9%-13%) increase in the probability of having a preventive dental checkup within a year. Individuals with a USC were more likely to obtain a preventive dental visit, with similar effects in rural and urban settings. We attributed the lower odds of having a checkup in rural regions to the lower density of oral health care providers in these areas. Integration of rural oral health care into primary care may help mitigate the challenges due to a shortage of oral health care providers in rural areas. © 2017 National Rural Health Association.

  10. End-of-Life Transitions and Hospice Utilization for Adolescents: Does Having a Usual Source of Care Matter?

    Science.gov (United States)

    Keim-Malpass, Jessica; Lindley, Lisa C

    2017-08-01

    Adolescents with life-limiting illnesses have intensive end-of-life trajectories and could benefit from initiation of hospice services. The medical home model, which includes having a usual source of primary care, may help facilitate quality outcomes at the end-of-life for adolescents. The purpose of this study was to determine the relationship between having a usual source of primary care on hospice utilization and end-of-life transitions among adolescents between 15-20 years with a life-limiting illness. A retrospective cohort design used 2007-2010 California Medicaid claims data (n=585). Our dependent variables were hospice utilization (i.e., hospice enrollment, hospice length of stay) and the independent variable was usual source of primary care. Multivariate regression techniques including least squares regression, multivariate logistic regression, and negative binomial regression were used in the analysis of the relationship between usual source of primary care and hospice utilization and end-of-life transitions. Ten percent of our sample utilized hospice services. Having a usual source of primary care was associated with an increase in hospice enrollment, hospice length of stay, and end-of-life transitions. Adolescents with a cancer diagnosis were more likely to enroll in hospice services. For adolescents at the end of life, having a usual source of primary care had a significant impact on hospice enrollment and length of stay. This study is among the first to demonstrate a relationship between primary care and hospice use among this vulnerable population.

  11. Insure Kids Now (IKN) (Dental Care Providers)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Insure Kids Now (IKN) Dental Care Providers in Your State locator provides profile information for oral health providers participating in Medicaid and Children's...

  12. Cost-effectiveness of a specialized atrial fibrillation clinic vs. usual care in patients with atrial fibrillation

    NARCIS (Netherlands)

    Hendriks, Jeroen; Tomini, Florian; van Asselt, Thea; Crijns, Harry; Vrijhoef, Hubertus

    AIMS: A recent randomized controlled trial demonstrated significant reductions in cardiovascular hospitalizations and deaths with a nurse-led integrated chronic care approach in patients with atrial fibrillation (AF) compared with usual care. The aim of the present study is to assess

  13. Cost-effectiveness of a specialized atrial fibrillation clinic vs. usual care in patients with atrial fibrillation

    NARCIS (Netherlands)

    Hendriks, J.M.L.; Tomini, F.; van Asselt, A.D.I.; Crijns, H.J.G.M.; Vrijhoef, H.J.M.

    2013-01-01

    Aims A recent randomized controlled trial demonstrated significant reductions in cardiovascular hospitalizations and deaths with a nurse-led integrated chronic care approach in patients with atrial fibrillation (AF) compared with usual care. The aim of the present study is to assess

  14. Joint recovery programme versus usual care - An economic evaluation of a clinical pathway for joint replacement surgery

    NARCIS (Netherlands)

    Brunenberg, DE; van Steyn, MJ; Sluimer, JC; Bekebrede, LL; Bulstra, SK; Joore, MA

    2005-01-01

    Objective: The objective of the present study was to determine the incremental cost-effectiveness of a clinical pathway for patients undergoing joint replacement, the Joint Recovery Programme (JRP), as compared with usual care. The existing care process was revised to contain costs and shorten

  15. Multistrategy childcare-based intervention to improve compliance with nutrition guidelines versus usual care in long day care services: a study protocol for a randomised controlled trial

    Science.gov (United States)

    Seward, Kirsty; Finch, Meghan; Wiggers, John; Wyse, Rebecca; Jones, Jannah; Gillham, Karen; Yoong, Sze Lin

    2016-01-01

    Introduction Interventions to improve child diet are recommended as dietary patterns developed in childhood track into adulthood and influence the risk of chronic disease. For child health, childcare services are required to provide foods to children consistent with nutrition guidelines. Research suggests that foods and beverages provided by services to children are often inconsistent with nutrition guidelines. The primary aim of this study is to assess, relative to a usual care control group, the effectiveness of a multistrategy childcare-based intervention in improving compliance with nutrition guidelines in long day care services. Methods and analysis The study will employ a parallel group randomised controlled trial design. A sample of 58 long day care services that provide all meals (typically includes 1 main and 2 mid-meals) to children while they are in care, in the Hunter New England region of New South Wales, Australia, will be randomly allocated to a 6-month intervention to support implementation of nutrition guidelines or a usual care control group in a 1:1 ratio. The intervention was designed to overcome barriers to the implementation of nutrition guidelines assessed using the theoretical domains framework. Intervention strategies will include the provision of staff training and resources, audit and feedback, ongoing support and securing executive support. The primary outcome of the trial will be the change in the proportion of long day care services that have a 2-week menu compliant with childcare nutrition guidelines, measured by comprehensive menu assessments. As a secondary outcome, child dietary intake while in care will also be assessed. To assess the effectiveness of the intervention, the measures will be undertaken at baseline and ∼6 months postbaseline. Ethics and dissemination The study was approved by the Hunter New England Human Research Ethics Committee. Study findings will be disseminated widely through peer-reviewed publications. PMID

  16. Economic evaluation of a multifactorial, interdisciplinary intervention versus usual care to reduce frailty in frail older people.

    Science.gov (United States)

    Fairhall, Nicola; Sherrington, Catherine; Kurrle, Susan E; Lord, Stephen R; Lockwood, Keri; Howard, Kirsten; Hayes, Alison; Monaghan, Noeline; Langron, Colleen; Aggar, Christina; Cameron, Ian D

    2015-01-01

    To compare the costs and cost-effectiveness of a multifactorial interdisciplinary intervention versus usual care for older people who are frail. Cost-effectiveness study embedded within a randomized controlled trial. Community-based intervention in Sydney, Australia. A total of 241 community-dwelling people 70 years or older who met the Cardiovascular Health Study criteria for frailty. A 12-month multifactorial, interdisciplinary intervention targeting identified frailty characteristics versus usual care. Health and social service use, frailty, and health-related quality of life (EQ-5D) were measured over the 12-month intervention period. The difference between the mean cost per person for 12 months in the intervention and control groups (incremental cost) and the ratio between incremental cost and effectiveness were calculated. A total of 216 participants (90%) completed the study. The prevalence of frailty was 14.7% lower in the intervention group compared with the control group at 12 months (95% CI 2.4%-27.0%; P = .02). There was no significant between-group difference in EQ-5D utility scores. The cost for 1 extra person to transition out of frailty was $A15,955 (at 2011 prices). In the "very frail" subgroup (participants met >3 Cardiovascular Health Study frailty criteria), the intervention was both more effective and less costly than the control. A cost-effectiveness acceptability curve shows that the intervention would be cost-effective with 80% certainty if decision makers were willing to pay $A50,000 per extra person transitioning from frailty. In the very frail subpopulation, this reduced to $25,000. For frail older people residing in the community, a 12-month multifactorial intervention provided better value for money than usual care, particularly for the very frail, in whom it has a high probability of being cost saving, as well as effective. Trial registration: ACTRN12608000250336. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care

  17. Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Lenferink, Anke; Brusse-Keizer, Marjolein; van der Valk, Paul Dlpm; Frith, Peter A; Zwerink, Marlies; Monninkhof, Evelyn M; van der Palen, Job; Effing, Tanja W

    2017-08-04

    Chronic Obstructive Pulmonary Disease (COPD) self-management interventions should be structured but personalised and often multi-component, with goals of motivating, engaging and supporting the patients to positively adapt their behaviour(s) and develop skills to better manage disease. Exacerbation action plans are considered to be a key component of COPD self-management interventions. Studies assessing these interventions show contradictory results. In this Cochrane Review, we compared the effectiveness of COPD self-management interventions that include action plans for acute exacerbations of COPD (AECOPD) with usual care. To evaluate the efficacy of COPD-specific self-management interventions that include an action plan for exacerbations of COPD compared with usual care in terms of health-related quality of life, respiratory-related hospital admissions and other health outcomes. We searched the Cochrane Airways Group Specialised Register of trials, trials registries, and the reference lists of included studies to May 2016. We included randomised controlled trials evaluating a self-management intervention for people with COPD published since 1995. To be eligible for inclusion, the self-management intervention included a written action plan for AECOPD and an iterative process between participant and healthcare provider(s) in which feedback was provided. We excluded disease management programmes classified as pulmonary rehabilitation or exercise classes offered in a hospital, at a rehabilitation centre, or in a community-based setting to avoid overlap with pulmonary rehabilitation as much as possible. Two review authors independently assessed trial quality and extracted data. We resolved disagreements by reaching consensus or by involving a third review author. Study authors were contacted to obtain additional information and missing outcome data where possible. When appropriate, study results were pooled using a random-effects modelling meta-analysis. The primary

  18. Cost-effectiveness of cognitive behaviour therapy versus talking and usual care for depressed older people in primary care

    Directory of Open Access Journals (Sweden)

    Leurent Baptiste E

    2011-02-01

    Full Text Available Abstract Background Whilst evidence suggests cognitive behaviour therapy (CBT may be effective for depressed older people in a primary care setting, few studies have examined its cost-effectiveness. The aim of this study was to compare the cost-effectiveness of cognitive behaviour therapy (CBT, a talking control (TC and treatment as usual (TAU, delivered in a primary care setting, for older people with depression. Methods Cost data generated from a single blind randomised controlled trial of 204 people aged 65 years or more were offered only Treatment as Usual, or TAU plus up to twelve sessions of CBT or a talking control is presented. The Beck Depression Inventory II (BDI-II was the main outcome measure for depression. Direct treatment costs were compared with reductions in depression scores. Cost-effectiveness analysis was conducted using non-parametric bootstrapping. The primary analysis focussed on the cost-effectiveness of CBT compared with TAU at 10 months follow up. Results Complete cost data were available for 198 patients at 4 and 10 month follow up. There were no significant differences between groups in baseline costs. The majority of health service contacts at follow up were made with general practitioners. Fewer contacts with mental health services were recorded in patients allocated to CBT, though these differences were not significant. Overall total per patient costs (including intervention costs were significantly higher in the CBT group compared with the TAU group at 10 month follow up (difference £427, 95% CI: £56 - £787, p Conclusions CBT is significantly more costly than TAU alone or TAU plus TC, but more clinically effective. Based on current estimates, CBT is likely to be recommended as a cost-effective treatment option for this patient group if the value placed on a unit reduction in BDI-II is greater than £115. Trial Registration isrctn.org Identifier: ISRCTN18271323

  19. Effectiveness of a lifestyle intervention led by female community health volunteers versus usual care in blood pressure reduction (COBIN)

    DEFF Research Database (Denmark)

    Neupane, Dinesh; McLachlan, Craig S; Mishra, Shiva Raj

    2018-01-01

    ). In the intervention group, 43 FCHVs provided home visits every 4 months for lifestyle counselling and blood pressure monitoring. Eligible participants had been involved in a previous population-based survey, were aged 25–65 years, did not have plans to migrate outside the study area, and were not severely ill......-income population. Methods We did a community-based, open-label, two-group, cluster-randomised controlled trial in Nepal. Using computer-generated codes, we randomly assigned (1:1) 14 clusters to a lifestyle intervention led by female community health volunteers (FCHVs) or usual care (control group...... participants (939 assigned to intervention; 699 assigned to control). At 1 year, 855 participants remained in the intervention group (425 were normotensive, 175 were prehypertensive, and 255 had hypertension) and 613 remained in the control group (305 were normotensive, 128 were prehypertensive, and 180 had...

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

    Science.gov (United States)

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

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

  1. Prehospital Providers' Perceptions on Providing Patient and Family Centered Care.

    Science.gov (United States)

    Ayub, Emily M; Sampayo, Esther M; Shah, Manish I; Doughty, Cara B

    2017-01-01

    A gap exists in understanding a provider's approach to delivering care that is mutually beneficial to patients, families, and other providers in the prehospital setting. The purpose of this study was to identify attitudes, beliefs, and perceived barriers to providing patient and family centered care (PFCC) in the prehospital setting and to describe potential solutions for improving PFCC during critical pediatric events. We conducted a qualitative, cross-sectional study of a purposive sample of Emergency Medical Technicians (EMTs) and paramedics from an urban, municipal, fire-based EMS system, who participated in the Pediatric Simulation Training for Emergency Prehospital Providers (PediSTEPPS) course. Two coders reviewed transcriptions of audio recordings from participants' first simulation scenario debriefings and performed constant comparison analysis to identify unifying themes. Themes were verified through member checking with two focus groups of prehospital providers. A total of 122 EMTs and paramedics participated in 16 audiotaped debriefing sessions and two focus groups. Four overarching themes emerged regarding the experience of PFCC by prehospital providers: (1) Perceived barriers included the prehospital environment, limited manpower, multi-tasking medical care, and concern for interference with patient care; (2) Providing emotional support comprised of empathetically comforting caregivers, maintaining a calm demeanor, and empowering families to feel involved; (3) Effective communication strategies consisted of designating a family point person, narration of actions, preempting the next steps, speaking in lay terms, summarizing during downtime, and conveying a positive first impression; (4) Tactics to overcome PFCC barriers were maintaining a line of sight, removing and returning a caregiver to and from the scene, and providing situational awareness. Based on debriefings from simulated scenarios, some prehospital providers identified the provision of

  2. Semi-Individualized Homeopathy Add-On Versus Usual Care Only for Premenstrual Disorders: A Randomized, Controlled Feasibility Study.

    Science.gov (United States)

    Klein-Laansma, Christien T; Jong, Mats; von Hagens, Cornelia; Jansen, Jean Pierre C H; van Wietmarschen, Herman; Jong, Miek C

    2018-03-22

    Premenstrual syndrome and premenstrual dysphoric disorder (PMS/PMDD) bother a substantial number of women. Homeopathy seems a promising treatment, but it needs investigation using reliable study designs. The feasibility of organizing an international randomized pragmatic trial on a homeopathic add-on treatment (usual care [UC] + HT) compared with UC alone was evaluated. A multicenter, randomized, controlled pragmatic trial with parallel groups. The study was organized in general and private homeopathic practices in the Netherlands and Sweden and in an outpatient university clinic in Germany. Women diagnosed as having PMS/PMDD, based on prospective daily rating by the daily record of severity of problems (DRSP) during a period of 2 months, were included and randomized. Women were to receive UC + HT or UC for 4 months. Homeopathic medicine selection was according to a previously tested prognostic questionnaire and electronic algorithm. Usual care was as provided by the women's general practitioner according to their preferences. Before and after treatment, the women completed diaries (DRSP), the measure yourself concerns and well-being, and other questionnaires. Intention-to-treat (ITT) and per protocol (PP) analyses were performed. In Germany, the study could not proceed because of legal limitations. In Sweden, recruitment proved extremely difficult. In the Netherlands and Sweden, 60 women were randomized (UC + HT: 28; UC: 32), data of 47/46 women were analyzed (ITT/PP). After 4 months, relative mean change of DRSP scores in the UC + HT group was significantly better than in the UC group (p = 0.03). With respect to recruitment and different legal status, it does not seem feasible to perform a larger, international, pragmatic randomized trial on (semi-)individualized homeopathy for PMS/PMDD. Since the added value of HT compared with UC was demonstrated by significant differences in symptom score changes, further studies are warranted.

  3. Substitution of Usual Perioperative Care by eHealth to Enhance Postoperative Recovery in Patients Undergoing General Surgical or Gynecological Procedures: Study Protocol of a Randomized Controlled Trial.

    NARCIS (Netherlands)

    Meij, E.; Huirne, J.A.F.; Bouwsma, E.V.A.; van Dongen, J.M.; Terwee, Caroline B; van de Ven, P.M.; Bakker, C.M.; van der Meij, S.; van Baal, W.M.; Leclercq, W.K.G.; Geomini, P.M.; Consten, E.C.; Schraffordt Koops, S.E.; van Kesteren, P.J.; Stockmann, H.B.; Ten Cate, A.D.; Davids, P.H.P.; Scholten, P.C.; van den Heuvel, B.; Schaafsma, Frederieke G.; Meijerink, W.J.; Bonjer, H.J.; Anema, J.R.

    2016-01-01

    BACKGROUND: Due to the strong reduction in the length of hospital stays in the last decade, the period of in-hospital postoperative care is limited. After discharge from the hospital, guidance and monitoring on recovery and resumption of (work) activities are usually not provided. As a consequence,

  4. Home care providers to the rescue

    DEFF Research Database (Denmark)

    Hansen, Steen Møller; Brøndum, Stig; Thomas, Grethe

    2015-01-01

    AIM: To describe the implementation of a novel first-responder programme in which home care providers equipped with automated external defibrillators (AEDs) were dispatched in parallel with existing emergency medical services in the event of a suspected out-of-hospital cardiac arrest (OHCA......). METHODS: We evaluated a one-year prospective study that trained home care providers in performing cardiopulmonary resuscitation (CPR) and using an AED in cases of suspected OHCA. Data were collected from cardiac arrest case files, case files from each provider dispatch and a survey among dispatched...... providers. The study was conducted in a rural district in Denmark. RESULTS: Home care providers were dispatched to 28 of the 60 OHCAs that occurred in the study period. In ten cases the providers arrived before the ambulance service and subsequently performed CPR. AED analysis was executed in three cases...

  5. Economic evaluation of an intensive group training protocol compared with usual care physiotherapy in patients with chronic low back pain

    NARCIS (Netherlands)

    van der Roer, N.; van Tulder, M.; van Mechelen, W.; de Vet, H.C.W.

    2008-01-01

    STUDY DESIGN. Economic evaluation from a societal perspective conducted alongside a randomized controlled trial with a follow-up of 52 weeks. OBJECTIVE. To evaluate the cost effectiveness and cost utility of an intensive group training protocol compared with usual care physiotherapy in patients with

  6. Treating Anxiety Disorders in Inner City Schools: Results from a Pilot Randomized Controlled Trial Comparing CBT and Usual Care

    Science.gov (United States)

    Ginsburg, Golda S.; Becker, Kimberly D.; Drazdowski, Tess K.; Tein, Jenn-Yun

    2012-01-01

    Background: The effectiveness of cognitive-behavioral treatment (CBT) in inner city schools, when delivered by novice CBT clinicians, and compared to usual care (UC), is unknown. Objective: This pilot study addressed this issue by comparing a modular CBT for anxiety disorders to UC in a sample of 32 volunteer youth (mean age 10.28 years, 63%…

  7. Multicultural Nursing: Providing Better Employee Care.

    Science.gov (United States)

    Rittle, Chad

    2015-12-01

    Living in an increasingly multicultural society, nurses are regularly required to care for employees from a variety of cultural backgrounds. An awareness of cultural differences focuses occupational health nurses on those differences and results in better employee care. This article explores the concept of culturally competent employee care, some of the non-verbal communication cues among cultural groups, models associated with completing a cultural assessment, and how health disparities in the workplace can affect delivery of employee care. Self-evaluation of the occupational health nurse for personal preferences and biases is also discussed. Development of cultural competency is a process, and occupational health nurses must develop these skills. By developing cultural competence, occupational health nurses can conduct complete cultural assessments, facilitate better communication with employees from a variety of cultural backgrounds, and improve employee health and compliance with care regimens. Tips and guidelines for facilitating communication between occupational health nurses and employees are also provided. © 2015 The Author(s).

  8. Effective communication with primary care providers.

    Science.gov (United States)

    Smith, Karen

    2014-08-01

    Effective communication requires direct interaction between the hospitalist and the primary care provider using a standardized method of information exchange with the opportunity to ask questions and assign accountability for follow-up roles. The discharge summary is part of the process but does not provide the important aspects of handoff, such as closed loop communication and role assignments. Hospital discharge is a significant safety risk for patients, with more than half of discharged patients experiencing at least one error. Hospitalist and primary care providers need to collaborate to develop a standardized system to communicate about shared patients that meets handoff requirements. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Effectiveness of a multifaceted implementation strategy compared to usual care on low back pain guideline adherence among general practitioners.

    Science.gov (United States)

    Suman, Arnela; Schaafsma, Frederieke G; van de Ven, Peter M; Slottje, Pauline; Buchbinder, Rachelle; van Tulder, Maurits W; Anema, Johannes R

    2018-05-11

    To improve patient care, and to reduce unnecessary referrals for diagnostic imaging and medical specialist care for low back pain, an evidence-based guideline for low back pain was developed in the Netherlands in 2010. The current study evaluated the effect of a multifaceted implementation strategy on guideline adherence among Dutch general practitioners. The implementation strategy included a multidisciplinary training, provision of educational material and an interactive website for healthcare professionals, supported by a multimedia eHealth intervention for patients with low back pain. Adherence was measured using performance indicators based on 3 months data extracted from the contacts with patients with low back pain recorded in the electronic medical records of participating general practitioners. Performance indicators were compared between two groups: a usual care group and an implementation group. Performance indicators were referrals to consultations with medical specialists, to diagnostic imaging, and to psychosocial and/or occupational physician consultations, and inquiries about psychosocial and occupational risk factors. The electronic medical records of 5130 patient contacts for LBP were analysed; 2453 patient contacts in the usual care group and 2677 patient contacts in the implementation group. Overall, rates of referral and of recorded inquiries regarding psychosocial and occupational risk factors remained low in both groups over time. The only statistically significant difference found was a reduction in the number of referrals to neurologists in the implementation group (from 100 (7%) to 50 (4%)) compared to the usual care group (from 48 (4%) to 50 (4%), (p strategy did not result in improved guideline adherence among general practitioners, and it is not recommended for widespread use. However, baseline referral rates in participating practices were already low, possibly leaving only little room for improvement. Inquiries for psychosocial and

  10. Effect of Endobronchial Coils vs Usual Care on Exercise Tolerance in Patients With Severe Emphysema: The RENEW Randomized Clinical Trial.

    Science.gov (United States)

    Sciurba, Frank C; Criner, Gerard J; Strange, Charlie; Shah, Pallav L; Michaud, Gaetane; Connolly, Timothy A; Deslée, Gaëtan; Tillis, William P; Delage, Antoine; Marquette, Charles-Hugo; Krishna, Ganesh; Kalhan, Ravi; Ferguson, J Scott; Jantz, Michael; Maldonado, Fabien; McKenna, Robert; Majid, Adnan; Rai, Navdeep; Gay, Steven; Dransfield, Mark T; Angel, Luis; Maxfield, Roger; Herth, Felix J F; Wahidi, Momen M; Mehta, Atul; Slebos, Dirk-Jan

    Preliminary clinical trials have demonstrated that endobronchial coils compress emphysematous lung tissue and may improve lung function, exercise tolerance, and symptoms in patients with emphysema and severe lung hyperinflation. To determine the effectiveness and safety of endobronchial coil treatment. Randomized clinical trial conducted among 315 patients with emphysema and severe air trapping recruited from 21 North American and 5 European sites from December 2012 through November 2015. Participants were randomly assigned to continue usual care alone (guideline based, including pulmonary rehabilitation and bronchodilators; n = 157) vs usual care plus bilateral coil treatment (n = 158) involving 2 sequential procedures 4 months apart in which 10 to 14 coils were bronchoscopically placed in a single lobe of each lung. The primary effectiveness outcome was difference in absolute change in 6-minute-walk distance between baseline and 12 months (minimal clinically important difference [MCID], 25 m). Secondary end points included the difference between groups in 6-minute walk distance responder rate, absolute change in quality of life using the St George's Respiratory Questionnaire (MCID, 4) and change in forced expiratory volume in the first second (FEV1; MCID, 10%). The primary safety analysis compared the proportion of participants experiencing at least 1 of 7 prespecified major complications. Among 315 participants (mean age, 64 years; 52% women), 90% completed the 12-month follow-up. Median change in 6-minute walk distance at 12 months was 10.3 m with coil treatment vs -7.6 m with usual care, with a between-group difference of 14.6 m (Hodges-Lehmann 97.5% CI, 0.4 m to ∞; 1-sided P = .02). Improvement of at least 25 m occurred in 40.0% of patients in the coil group vs 26.9% with usual care (odds ratio, 1.8 [97.5% CI, 1.1 to ∞]; unadjusted between-group difference, 11.8% [97.5% CI, 1.0% to ∞]; 1-sided P = .01). The between-group difference in

  11. Standardizing communication from acute care providers to primary care providers on critically ill adults.

    Science.gov (United States)

    Ellis, Kerri A; Connolly, Ann; Hosseinnezhad, Alireza; Lilly, Craig M

    2015-11-01

    To increase the frequency of communication of patient information between acute and primary care providers. A secondary objective was to determine whether higher rates of communication were associated with lower rates of hospital readmission 30 days after discharge. A validated instrument was used for telephone surveys before and after an intervention designed to increase the frequency of communication among acute care and primary care providers. The communication intervention was implemented in 3 adult intensive care units from 2 campuses of an academic medical center. The frequency of communication among acute care and primary care providers, the perceived usefulness of the intervention, and its association with 30-day readmission rates were assessed for 202 adult intensive care episodes before and 100 episodes after a communication intervention. The frequency of documented communication increased significantly (5/202 or 2% before to 72/100 or 72% after the intervention; P communication was considered useful by every participating primary care provider. Rates of rehospitalization at 30 days were lower for the intervention group than the preintervention group, but the difference was not statistically significant (41/202 or 23% vs 16/88 or 18% of discharged patients; P = .45; power 0.112 at P = .05). The frequency of communication episodes that provide value can be increased through standardized processes. The key aspects of this effective intervention were setting the expectation that communication should occur, documenting when communication has occurred, and reviewing that documentation during multiprofessional rounds. ©2015 American Association of Critical-Care Nurses.

  12. Effect of a Collaborative Care Intervention vs Usual Care on Health Status of Patients With Chronic Heart Failure: The CASA Randomized Clinical Trial.

    Science.gov (United States)

    Bekelman, David B; Allen, Larry A; McBryde, Connor F; Hattler, Brack; Fairclough, Diane L; Havranek, Edward P; Turvey, Carolyn; Meek, Paula M

    2018-04-01

    Many patients with chronic heart failure experience reduced health status despite receiving conventional therapy. To determine whether a symptom and psychosocial collaborative care intervention improves heart failure-specific health status, depression, and symptom burden in patients with heart failure. A single-blind, 2-arm, multisite randomized clinical trial was conducted at Veterans Affairs, academic, and safety-net health systems in Colorado among outpatients with symptomatic heart failure and reduced health status recruited between August 2012 and April 2015. Data from all participants were included regardless of level of participation, using an intent-to-treat approach. Patients were randomized 1:1 to receive the Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) intervention or usual care. The CASA intervention included collaborative symptom care provided by a nurse and psychosocial care provided by a social worker, both of whom worked with the patients' primary care clinicians and were supervised by a study primary care clinician, cardiologist, and palliative care physician. The primary outcome was patient-reported heart failure-specific health status, measured by difference in change scores on the Kansas City Cardiomyopathy Questionnaire (range, 0-100) at 6 months. Secondary outcomes included depression (measured by the 9-item Patient Health Questionnaire), anxiety (measured by the 7-item Generalized Anxiety Disorder Questionnaire), overall symptom distress (measured by the General Symptom Distress Scale), specific symptoms (pain, fatigue, and shortness of breath), number of hospitalizations, and mortality. Of 314 patients randomized (157 to intervention arm and 157 to control arm), there were 67 women and 247 men, mean (SD) age was 65.5 (11.4) years, and 178 (56.7%) had reduced ejection fraction. At 6 months, the mean Kansas City Cardiomyopathy Questionnaire score improved 5.5 points in the intervention arm and 2.9 points in the control

  13. Comparative Effectiveness of Usual Source of Care Approaches to Improve End-of-Life Outcomes for Children With Intellectual Disability.

    Science.gov (United States)

    Lindley, Lisa C; Cozad, Melanie J

    2017-09-01

    Children with intellectual disability (ID) are at risk for adverse end-of-life outcomes including high emergency room utilization and hospital readmissions, along with low hospice enrollment. The objective of this study was to compare the effectiveness of usual source of care approaches to improve end-of-life outcomes for children with ID. We used longitudinal California Medicaid claims data. Children were included who were 21 years with fee-for-service Medicaid claims, died between January 1, 2007, and December 31, 2010, and had a moderate-to-profound ID diagnosis. End-of-life outcomes (i.e., hospice enrollment, emergency room utilization, hospital readmissions) were measured via claims data. Our treatments were usual source of care (USC) only vs. usual source of care plus targeted case management (USC plus TCM). Using instrumental variable analysis, we compared the effectiveness of treatments on end-of-life outcomes. Ten percent of children with ID enrolled in hospice, 73% used the emergency room, and 20% had three or more hospital admissions in their last year of life. USC plus TCM relative to USC only had no effect on hospice enrollment; however, it significantly reduced the probability of emergency room utilization (B = -1.29, P life outcomes for children with ID. Further study of the extent of UCS and TCM involvement in reducing emergency room utilization and hospital readmissions at end of life is needed. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  14. Randomized clinical trial of an intravenous hydromorphone titration protocol versus usual care for management of acute pain in older emergency department patients.

    Science.gov (United States)

    Chang, Andrew K; Bijur, Polly E; Davitt, Michelle; Gallagher, E John

    2013-09-01

    0.5 mg provides comparable analgesia to usual care with less opioid over 60 min.

  15. Pediatric Primary Care Providers' Relationships with Mental Health Care Providers: Survey Results

    Science.gov (United States)

    Pidano, Anne E.; Honigfeld, Lisa; Bar-Halpern, Miri; Vivian, James E.

    2014-01-01

    Background: As many as 20 % of children have diagnosable mental health conditions and nearly all of them receive pediatric primary health care. However, most children with serious mental health concerns do not receive mental health services. This study tested hypotheses that pediatric primary care providers (PPCPs) in relationships with mental…

  16. Study protocol: Cost-effectiveness of transmural nutritional support in malnourished elderly patients in comparison with usual care

    Directory of Open Access Journals (Sweden)

    van Bokhorst-de van der Schueren Marian AE

    2010-02-01

    Full Text Available Abstract Background Malnutrition is a common consequence of disease in older patients. Both in hospital setting and in community setting oral nutritional support has proven to be effective. However, cost-effectiveness studies are scarce. Therefore, the aim of our study is to investigate the effectiveness and cost-effectiveness of transmural nutritional support in malnourished elderly patients, starting at hospital admission until three months after discharge. Methods This study is a randomized controlled trial. Patients are included at hospital admission and followed until three months after discharge. Patients are eligible to be included when they are ≥ 60 years old and malnourished according to the following objective standards: Body Mass Index (BMI in kg/m2 Conclusion In this randomized controlled trial we will evaluate the effect of transmural nutritional support in malnourished elderly patients after hospital discharge, compared to usual care. Primary endpoints of the study are changes in activities of daily living, body weight, body composition, quality of life, and muscle strength. An economic evaluation will be performed to evaluate the cost-effectiveness of the intervention in comparison with usual care. Trial registration Netherlands Trial Register (ISRCTN29617677, registered 14-Sep-2005

  17. Dissemination of the nurse-administered Tobacco Tactics intervention versus usual care in six Trinity community hospitals: study protocol for a comparative effectiveness trial

    Directory of Open Access Journals (Sweden)

    Duffy Sonia A

    2012-08-01

    Full Text Available Abstract Background The objectives of this smoking cessation study among hospitalized smokers are to: 1 determine provider and patient receptivity, barriers, and facilitators to implementing the nurse-administered, inpatient Tobacco Tactics intervention versus usual care using face-to-face feedback and surveys; 2 compare the effectiveness of the nurse-administered, inpatient Tobacco Tactics intervention versus usual care across hospitals, units, and patient characteristics using thirty-day point prevalence abstinence at thirty days and six months (primary outcome post-recruitment; and 3 determine the cost-effectiveness of the nurse-administered, inpatient Tobacco Tactics intervention relative to usual care including cost per quitter, cost per life-year saved, and cost per quality-adjusted life-year saved. Methods/Design This effectiveness study will be a quasi-experimental design of six Michigan community hospitals of which three will get the nurse-administered Tobacco Tactics intervention and three will provide their usual care. In both the intervention and usual care sites, research assistants will collect data from patients on their smoking habits and related variables while in the hospital and at thirty days and six months post-recruitment. The intervention will be integrated into the experimental sites by a research nurse who will train Master Trainers at each intervention site. The Master Trainers, in turn, will teach the intervention to all staff nurses. Research nurses will also conduct formative evaluation with nurses to identify barriers and facilitators to dissemination. Descriptive statistics will be used to summarize the results of surveys administered to nurses, nurses’ participation rates, smokers’ receipt of specific cessation services, and satisfaction with services. General estimating equation analyses will be used to determine differences between intervention groups on satisfaction and quit rates, respectively, with

  18. Having a usual source of care and its associated factors in Korean adults: a cross-sectional study of the 2012 Korea Health Panel Survey.

    Science.gov (United States)

    An, Ah Reum; Kim, Kyoungwoo; Lee, Jae-Ho; Sung, Nak-Jin; Lee, Sang-Il; Hyun, Min Kyung

    2016-11-29

    Usual source of care (USC) is one of the hallmarks of primary care. We aimed to examine the status of having a USC and its patient-related sociodemographic factors among Korean adults. Data were obtained from the 2012 Korea Health Panel survey. Panel participants were selected for the study who were aged 18 years or older and who replied to questionnaire items on having a USC (n = 11,935). Of the participants, 21.5% had a usual place and 13.9% had a usual physician. Reasons for not having a USC were seldom being ill (66.1%), the preference to visit multiple medical institutions (27.9%), and others. The private community clinic was the most common type of usual place (57.0%). In patient-reported attributes of care provided by a usual physician, the percentages of positive responses for comprehensiveness and coordination were 67.2% and 34.5%, respectively. By institution type, primary care clinics showed the lowest percentage (32.8%) of positive responses for coordination. Adjusted odds ratios of having a usual physician were 3.77 (95% confidence interval, CI: 3.75-3.79) for those aged 65 years or older (vs. aged 18-34 years), 1.31 (CI: 1.30-1.31) for females (vs. males), 0.72 (CI: 0.72-0.73) for unmarried people (vs. married), 1.16 (CI: 1.16-1.16) for college graduates or higher (vs. elementary school graduate or less), 0.64 for the fifth quintile (vs. the first quintile) by household income, 1.53 (CI: 1.52-1.54) for Medical Aid (vs. employee health insurance) for type of health insurance, and 4.09 (CI: 4.08-4.10) for presence (vs. absence) of a chronic diseases. The proportion of Korean adults who have a USC is extremely low, the most influential factor of having a USC is having a chronic disease or not, and Korean patients experience much poorer health care coordination than do patients in other industrialized countries. The findings of this study will give insight to researchers and policy makers regarding the potential facilitators of and barriers to

  19. Economic evaluation of an intensive group training protocol compared with usual care physiotherapy in patients with chronic low back pain.

    Science.gov (United States)

    van der Roer, Nicole; van Tulder, Maurits; van Mechelen, Willem; de Vet, Henrica

    2008-02-15

    Economic evaluation from a societal perspective conducted alongside a randomized controlled trial with a follow-up of 52 weeks. To evaluate the cost effectiveness and cost utility of an intensive group training protocol compared with usual care physiotherapy in patients with nonspecific chronic low back pain. The intensive group training protocol combines exercise therapy, back school, and behavioral principles. Two studies found a significant reduction in absenteeism for a graded activity program in occupational health care. This program has not yet been evaluated in a primary care physiotherapy setting. Participating physical therapists in primary care recruited 114 patients with chronic nonspecific low back pain. Eligible patients were randomized to either the protocol group or the guideline group. Outcome measures included functional status (Roland Morris Disability Questionnaire), pain intensity (11-point numerical rating scale), general perceived effect and quality of life (EuroQol-5D). Cost data were measured with cost diaries and included direct and indirect costs related to low back pain. After 52 weeks, the direct health care costs were significantly higher for patients in the protocol group, largely due to the costs of the intervention. The mean difference in total costs amounted to [Euro sign] 233 (95% confidence interval: [Euro sign] -2.185; [Euro sign] 2.764). The cost-effectiveness planes indicated no significant differences in cost effectiveness between the 2 groups. The results of this economic evaluation showed no difference in total costs between the protocol group and the guideline group. The differences in effects were small and not statistically significant. At present, national implementation of the protocol is not recommended.

  20. Skin care education and individual counselling versus treatment as usual in healthcare workers with hand eczema: randomised clinical trial.

    Science.gov (United States)

    Ibler, Kristina Sophie; Jemec, Gregor B E; Diepgen, Thomas L; Gluud, Christian; Lindschou Hansen, Jane; Winkel, Per; Thomsen, Simon Francis; Agner, Tove

    2012-12-12

    To evaluate the effect of a secondary prevention programme with education on skin care and individual counselling versus treatment as usual in healthcare workers with hand eczema. Randomised, observer blinded parallel group superiority clinical trial. Three hospitals in Denmark. 255 healthcare workers with self reported hand eczema within the past year randomised centrally and stratified by profession, severity of eczema, and hospital. 123 were allocated to the intervention group and 132 to the control group. Education in skin care and individual counselling based on patch and prick testing and assessment of work and domestic related exposures. The control was treatment as usual. The primary outcome was clinical severity of disease at five month follow-up measured by scores on the hand eczema severity index. The secondary outcomes were scores on the dermatology life quality index, self evaluated severity of hand eczema, skin protective behaviours, and knowledge of hand eczema from onset to follow-up. Follow-up data were available for 247 of 255 participants (97%). At follow-up, the mean score on the hand eczema severity index was significantly lower (improved) in the intervention group than control group: difference of means, unadjusted -3.56 (95% confidence interval -4.92 to -2.14); adjusted -3.47 (-4.80 to -2.14), both Pgroup at follow-up: difference of means: unadjusted -0.78, non-parametric test P=0.003; adjusted -0.92, -1.48 to -0.37). Self evaluated severity and skin protective behaviour by hand washings and wearing of protective gloves were also statistically significantly better in the intervention group, whereas this was not the case for knowledge of hand eczema. A secondary prevention programme for hand eczema improved severity and quality of life and had a positive effect on self evaluated severity and skin protective behaviour by hand washings and wearing of protective gloves. ClinicalTrials.gov NCT01012453.

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

    NARCIS (Netherlands)

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

    2007-01-01

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

  2. Cost-effectiveness of counselling, graded-exercise and usual care for chronic fatigue: evidence from a randomised trial in primary care

    Directory of Open Access Journals (Sweden)

    Sabes-Figuera Ramon

    2012-08-01

    Full Text Available Abstract Background Fatigue is common and has been shown to result in high economic costs to society. The aim of this study is to compare the cost-effectiveness of two active therapies, graded-exercise (GET and counselling (COUN with usual care plus a self-help booklet (BUC for people presenting with chronic fatigue. Methods A randomised controlled trial was conducted with participants consulting for fatigue of over three months’ duration recruited from 31 general practices in South East England and allocated to one of three arms. Outcomes and use of services were assessed at 6-month follow-up. The main outcome measure used in the economic evaluation was clinically significant improvements in fatigue, measured using the Chalder fatigue scale. Cost-effectiveness was assessed using the net-benefit approach and cost-effectiveness acceptability curves. Results Full economic and outcome data at six months were available for 163 participants; GET = 51, COUN = 58 and BUC = 54. Those receiving the active therapies (GET and COUN had more contacts with care professionals and therefore higher costs, these differences being statistically significant. COUN was more expensive and less effective than the other two therapies. The incremental cost-effectiveness ratio of GET compared to BUC was equal to £987 per unit of clinically significant improvement. However, there was much uncertainty around this result. Conclusion This study does not provide a clear recommendation about which therapeutic option to adopt, based on efficiency, for patients with chronic fatigue. It suggests that COUN is not cost-effective, but it is unclear whether GET represents value for money compared to BUC. Clinical Trial Registration number at ISRCTN register: 72136156

  3. Trends in the Types of Usual Sources of Care: A Shift from People to Places or Nothing at All.

    Science.gov (United States)

    Liaw, Winston; Jetty, Anuradha; Petterson, Stephen; Bazemore, Andrew; Green, Larry

    2017-08-31

    (1) To examine usual source of care (USC) trends across four categories (No USC, Person USC, Person, in Facility USC, and Facility USC), and (2) to determine whether USC types are associated with emergency department (ED) visits and hospital admissions. 1996-2014 Medical Expenditure Panel Surveys. We stratified each USC category, by age, region, gender, poverty, insurance, race/ethnicity, and education and used regression to determine the characteristics associated with USC types, ED visits, and hospital admissions. Those with No USC and Facility USCs increased 10 and 18 percent, respectively, while those with Person USCs decreased by 43 percent. Compared to those in the lowest income bracket, those in the highest income bracket were less likely to have a Facility USC. Among those with low incomes, individuals with No USC, Person, in Facility, and Facility USCs were more likely to have ED visits than those with Person USCs. A growing number are reporting facilities as their USCs or none at all. The impact of these trends is uncertain, although we found that some USC types are associated with ED visits and hospital admissions. Tracking USCs will be crucial to measuring progress toward enhanced care efficiency. © Health Research and Educational Trust.

  4. Providing Palliative Care to LGBTQ Patients.

    Science.gov (United States)

    Barrett, Nina; Wholihan, Dorothy

    2016-09-01

    Nurses should be familiar with and equipped to address the challenges that arise when caring for lesbian, gay, bisexual, transgender, or queer-identified (LGBTQ) patients. LGBTQ individuals have increased rates of certain physical diseases and are at greater risk of suffering from stress-sensitive mental health issues. Negative social attitudes, widespread discrimination and stigma, physical and psychological victimization, and less social support with aging contribute to the complexity of care for these individuals. Open communication, welcoming and accepting attitudes and environments, and sensitivity to unique multidimensional issues improve care to LGBTQ patients with serious advanced illness. Nursing can reach this vulnerable minority and positively impact the quality of care. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Occupational Health for Health Care Providers

    Science.gov (United States)

    Health care workers are exposed to many job hazards. These can include Infections Needle injuries Back injuries ... prevention practices. They can reduce your risk of health problems. Use protective equipment, follow infection control guidelines, ...

  6. Providing pediatric palliative care: PACT in action.

    Science.gov (United States)

    Duncan, Janet; Spengler, Emily; Wolfe, Joanne

    2007-01-01

    High-quality pediatric palliative care should be an expected standard in the United States, especially since the publication of the numerous position statements such as "Precepts of Palliative Care for Children and Adolescents and Their Families," a joint statement created by the Association of Pediatric Oncology Nurses, the National Association of Neonatal Nurses, and the Society of Pediatric Nurses. Although many barriers still exist, dedicated individuals and teams strive to promote models of excellence and improve care for children with life-threatening conditions and their families. The Pediatric Advanced Care Team, a joint project of Dana-Farber Cancer Institute and Children's Hospital, Boston, is one such interdisciplinary pediatric palliative care consultation service. Founded in 1997, we have grown and learned from formal study and our extensive clinical work with families, children, and our colleagues. This article describes our journey as an interdisciplinary team forging a new service within two renowned medical institutions in which historically the primary emphasis of care has been on cure and innovation. Although these values remain, our work has resulted in an increased acceptance of balancing treatment of the underlying disease or condition along with treatment of the physical, psychosocial, and spiritual needs of the child and family through life or death. One of our goals is to help promote a balance of hope for cure with hope for comfort, dignity, and integrity for every child and family.

  7. Fibromyalgia: management strategies for primary care providers.

    Science.gov (United States)

    Arnold, L M; Gebke, K B; Choy, E H S

    2016-02-01

    Fibromyalgia (FM), a chronic disorder defined by widespread pain, often accompanied by fatigue and sleep disturbance, affects up to one in 20 patients in primary care. Although most patients with FM are managed in primary care, diagnosis and treatment continue to present a challenge, and patients are often referred to specialists. Furthermore, the lack of a clear patient pathway often results in patients being passed from specialist to specialist, exhaustive investigations, prescription of multiple drugs to treat different symptoms, delays in diagnosis, increased disability and increased healthcare resource utilisation. We will discuss the current and evolving understanding of FM, and recommend improvements in the management and treatment of FM, highlighting the role of the primary care physician, and the place of the medical home in FM management. We reviewed the epidemiology, pathophysiology and management of FM by searching PubMed and references from relevant articles, and selected articles on the basis of quality, relevance to the illness and importance in illustrating current management pathways and the potential for future improvements. The implementation of a framework for chronic pain management in primary care would limit unnecessary, time-consuming, and costly tests, reduce diagnostic delay and improve patient outcomes. The patient-centred medical home (PCMH), a management framework that has been successfully implemented in other chronic diseases, might improve the care of patients with FM in primary care, by bringing together a team of professionals with a range of skills and training. Although there remain several barriers to overcome, implementation of a PCMH would allow patients with FM, like those with other chronic conditions, to be successfully managed in the primary care setting. © 2016 John Wiley & Sons Ltd.

  8. Special Sitters: Youth as Respite Care Providers.

    Science.gov (United States)

    Edgar, Eugene B.; And Others

    1988-01-01

    A training program taught 120 teenage sitters child care skills identified as important by parents (N=250) of children with disabilities. Training included first aid and 15 hours of instruction emphasizing communication, responsive play, simple behavior management, handling of emergencies, and interviews with parents. The program also linked…

  9. Multicomponent intervention versus usual care for management of hypertension in rural Bangladesh, Pakistan and Sri Lanka: study protocol for a cluster randomized controlled trial.

    Science.gov (United States)

    Jafar, Tazeen H; Jehan, Imtiaz; de Silva, H Asita; Naheed, Aliya; Gandhi, Mihir; Assam, Pryseley; Finkelstein, Eric A; Quigley, Helena Legido; Bilger, Marcel; Khan, Aamir Hameed; Clemens, John David; Ebrahim, Shah; Turner, Elizabeth L; Kasturiratne, Anuradhani

    2017-06-12

    High blood pressure (BP) is the leading attributable risk for cardiovascular disease (CVD). In rural South Asia, hypertension continues to be a significant public health issue with sub-optimal BP control rates. The goal of the trial is to compare a multicomponent intervention (MCI) to usual care to evaluate the effectiveness and cost-effectiveness of the MCI for lowering BP among adults with hypertension in rural communities in Bangladesh, Pakistan and Sri Lanka. This study is a stratified, cluster randomized controlled trial with a qualitative component for evaluation of processes and stakeholder feedback. The MCI has five components: (1) home health education by government community health workers (CHWs), (2) BP monitoring and stepped-up referral to a trained general practitioner using a checklist, (3) training public and private providers in management of hypertension and using a checklist, (4) designating hypertension triage counter and hypertension care coordinators in government clinics and (5) a financing model to compensate for additional health services and provide subsidies to low income individuals with poorly controlled hypertension. Usual care will comprise existing services in the community without any additional training. The trial will be conducted on 2550 individuals aged ≥40 years with hypertension (with systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, based on the mean of the last two of three measurements from two separate days, or on antihypertensive therapy) in 30 rural communities in Bangladesh, Pakistan and Sri Lanka. The primary outcome is change in systolic BP from baseline to follow-up at 24 months post-randomization. The incremental cost of MCI per CVD disability-adjusted life years averted will be computed. Stakeholders including policy makers, provincial- and district-level coordinators of relevant programmes, physicians, CHWs, key community leaders, hypertensive individuals and family members in the identified clusters will

  10. Blended care vs. usual care in the treatment of depressive symptoms and disorders in general practice [BLENDING]: study protocol of a non-inferiority randomized trial.

    Science.gov (United States)

    Massoudi, Btissame; Blanker, Marco H; van Valen, Evelien; Wouters, Hans; Bockting, Claudi L H; Burger, Huibert

    2017-06-13

    The majority of patients with depressive disorders are treated by general practitioners (GPs) and are prescribed antidepressant medication. Patients prefer psychological treatments but they are under-used, mainly due to time constraints and limited accessibility. A promising approach to deliver psychological treatment is blended care, i.e. guided online treatment. However, the cost-effectiveness of blended care formatted as an online psychological treatment supported by the patients' own GP or general practice mental health worker (MHW) in routine primary care is unknown. We aim to demonstrate non-inferiority of blended care compared with usual care in patients with depressive symptoms or a depressive disorder in general practice. Additionally, we will explore the real-time course over the day of emotions and affect, and events within individuals during treatment. This is a pragmatic non-inferiority trial including 300 patients with depressive symptoms, recruited by collaborating GPs and MHWs. After inclusion, participants are randomized to either blended care or usual care in routine general practice. Blended care consists of the 'Act and Feel' treatment: an eight-week web-based program based on behavioral activation with integrated monitoring of depressive symptomatology and automatized feedback. GPs or their MHWs coach the participants through regular face-to-face or telephonic consultations with at least three sessions. Depressive symptomatology, health status, functional impairment, treatment satisfaction, daily activities and resource use are assessed during a follow-up period of 12 months. During treatment, real-time fluctuations in emotions and affect, and daily events will be rated using ecological momentary assessment. The primary outcome is the reduction of depressive symptoms from baseline to three months follow-up. We will conduct intention-to-treat analyses and supplementary per-protocol analyses. This trial will show whether blended care might be an

  11. Who Cares for Kids? A Report on Child Care Providers.

    Science.gov (United States)

    Benson, Carolyn

    This study offers a profile of child care workers in family day care homes and child care centers, reporting general statistics and examining their wages, benefits, training, working conditions, and turnover rates. In addition, it looks at government regulation and licensing, employer-sponsored programs, child abuse, insurance rates, and federal…

  12. The expectations of fathers concerning care provided by midwives to ...

    African Journals Online (AJOL)

    2012-04-06

    Apr 6, 2012 ... qualitative interviews were conducted with fathers about the care provided to their .... Caring, care: (Note: In this study the terms 'care' and 'caring' .... the coder to compare and discuss their analysis in order to ..... contact and by talking. ... couple; fathers focused on the baby's face, open eyes and facial.

  13. Health Care Providers' Spirit at Work Within a Restructured Workplace.

    Science.gov (United States)

    Wagner, Joan I J; Brooks, Denise; Urban, Ann-Marie

    2018-01-01

    Spirit at work (SAW) research emerged as a response to care provider determination to maintain a healthy and productive health care work environment, despite restructuring. The aim of this descriptive mixed-methods research is to present the care provider's perceptions of SAW. SAW is a holistic measure of care provider workplace outcomes, defined as the unique experience of individuals who are passionate about and energized by their work. A mixed group of licensed and unlicensed care providers in a continuing care workplace were surveyed. Eighteen Likert-type scale survey questions were further informed by two open-ended questions. Results indicated that unlicensed continuing care providers' perceptions of SAW are lower than licensed care providers. Responses suggest that open discussion between managers and team members, combined with structured workplace interventions, will lead to enhanced SAW and improved patient care. Further research on SAW within the continuing care workplace is required.

  14. Mechanisms underlying mindfulness-based addiction treatment versus cognitive behavioral therapy and usual care for smoking cessation.

    Science.gov (United States)

    Spears, Claire Adams; Hedeker, Donald; Li, Liang; Wu, Cai; Anderson, Natalie K; Houchins, Sean C; Vinci, Christine; Hoover, Diana Stewart; Vidrine, Jennifer Irvin; Cinciripini, Paul M; Waters, Andrew J; Wetter, David W

    2017-11-01

    To examine cognitive and affective mechanisms underlying mindfulness-based addiction treatment (MBAT) versus cognitive-behavioral therapy (CBT) and usual care (UC) for smoking cessation. Participants in the parent study from which data were drawn (N = 412; 54.9% female; 48.2% African American, 41.5% non-Latino White, 5.4% Latino, 4.9% other; 57.6% annual income <$30,000) were randomized to MBAT (n = 154), CBT (n = 155), or UC (n = 103). From quit date through 26 weeks postquit, participants completed measures of emotions, craving, dependence, withdrawal, self-efficacy, and attentional bias. Biochemically confirmed 7-day smoking abstinence was assessed at 4 and 26 weeks postquit. Although the parent study did not find a significant treatment effect on abstinence, mixed-effects regression models were conducted to examine treatment effects on hypothesized mechanisms, and indirect effects of treatments on abstinence were tested. Participants receiving MBAT perceived greater volitional control over smoking and evidenced lower volatility of anger than participants in both other treatments. However, there were no other significant differences between MBAT and CBT. Compared with those receiving UC, MBAT participants reported lower anxiety, concentration difficulties, craving, and dependence, as well as higher self-efficacy for managing negative affect without smoking. Indirect effects of MBAT versus UC on abstinence occurred through each of these mechanisms. Whereas several differences emerged between MBAT and UC, MBAT and CBT had similar effects on several of the psychosocial mechanisms implicated in tobacco dependence. Results help to shed light on similarities and differences between mindfulness-based and other active smoking cessation treatments. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  15. Usual care and management of fall risk increasing drugs in older dizzy patients in Dutch general practice

    Science.gov (United States)

    Stam, Hanneke; Harting, Thomas; van der Sluijs, Marjolijn; van Marum, Rob; van der Horst, Henriëtte; van der Wouden, Johannes C.; Maarsingh, Otto R.

    2016-01-01

    Objective For general practitioners (GPs) dizziness is a challenging condition to deal with. Data on the management of dizziness in older patients are mostly lacking. Furthermore, it is unknown whether GPs attempt to decrease Fall Risk Increasing Drugs (FRIDs) use in the management of dizziness in older patients. The aim of this study is to gain more insight into GP’s management of dizziness in older patients, including FRID evaluation and adjustment. Design Data were derived from electronic medical records, obtained over a 12-month period in 2013. Setting Forty-six Dutch general practices. Patients The study sample comprised of 2812 older dizzy patients of 65 years and over. Patients were identified using International Classification of Primary Care codes and free text. Main outcome measures Usual care was categorized into wait-and-see strategy (no treatment initiated); education and advice; additional testing; medication adjustment; and referral. Results Frequently applied treatments included a wait-and-see strategy (28.4%) and education and advice (28.0%). Additional testing was performed in 26.8%; 19.0% of the patients were referred. Of the patients 87.2% had at least one FRID prescription. During the observation period, GPs adjusted the use of one or more FRIDs for 11.7% of the patients. Conclusion This study revealed a wide variety in management strategies for dizziness in older adults. The referral rate for dizziness was high compared to prior research. Although many older dizzy patients use at least one FRID, FRID evaluation and adjustment is scarce. We expect that more FRID adjustments may reduce dizziness and dizziness-related impairment. Key PointsIt is important to know how general practitioners manage dizziness in older patients in order to assess potential cues for improvement.This study revealed a wide variety in management strategies for dizziness in older patients.There was a scarcity in Fall Risk Increasing Drug (FRID) evaluation and adjustment

  16. Social media usage among health care providers.

    Science.gov (United States)

    Surani, Zoya; Hirani, Rahim; Elias, Anita; Quisenberry, Lauren; Varon, Joseph; Surani, Sara; Surani, Salim

    2017-11-29

    The objective of this study was to evaluate the use of social media among healthcare workers in an attempt to identify how it affects the quality of patient care. An anonymous survey of 35 questions was conducted in South Texas, on 366 healthcare workers. Of the 97% of people who reported owning electronic devices, 87.9% indicated that they used social media. These healthcare workers indicated that they spent approximately 1 h on social media every day. The healthcare workers below the age of 40 were more involved in social media compared to those above 40 (p social media among physicians and nurses was noted to be identical (88% for each group), and both groups encouraged their patients to research their clinical conditions on social media (p social media policy in their hospital compared to nurses (p < 0.05). However, a large proportion of healthcare workers (40%) were unaware of their workplace policy, which could potentially cause a privacy breach of confidential medical information. Further studies are required to evaluate specific effects of these findings on the quality of patient care.

  17. Hospital-at-home Integrated Care Program for Older Patients With Orthopedic Processes: An Efficient Alternative to Usual Hospital-Based Care.

    Science.gov (United States)

    Closa, Conxita; Mas, Miquel À; Santaeugènia, Sebastià J; Inzitari, Marco; Ribera, Aida; Gallofré, Miquel

    2017-09-01

    To compare outcomes and costs for patients with orthogeriatric conditions in a home-based integrated care program versus conventional hospital-based care. Quasi-experimental longitudinal study. An acute care hospital, an intermediate care hospital, and the community of an urban area in the North of Barcelona, in Southern Europe. In a 2-year period, we recruited 367 older patients attended at an orthopedic/traumatology unit in an acute hospital for fractures and/or arthroplasty. Patients were referred to a hospital-at-home integrated care unit or to standard hospital-based postacute orthogeriatric unit, based on their social support and availability of the resource. We compared home-based care versus hospital-based care for Relative Functional Gain (gain/loss of function measured by the Barthel Index), mean direct costs, and potential savings in terms of reduction of stay in the acute care hospital. No differences were found in Relative Functional Gain, median (Q25-Q75) = 0.92 (0.64-1.09) in the home-based group versus 0.93 (0.59-1) in the hospital-based group, P =.333. Total health service direct cost [mean (standard deviation)] was significantly lower for patients receiving home-based care: €7120 (3381) versus €12,149 (6322), P home-based care [10.1 (7)] than in patients discharged to the postacute orthogeriatric hospital-based unit [15.3 (12) days, P home integrated care program was suitable for managing older patients with orthopedic conditions who have good social support for home care. It provided clinical care comparable to the hospital-based model, and it seems to enable earlier acute hospital discharge and lower direct costs. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  18. Effect of reversal of neuromuscular blockade with sugammadex versus usual care on bleeding risk in a randomized study of surgical patients.

    Science.gov (United States)

    Rahe-Meyer, Niels; Fennema, Hein; Schulman, Sam; Klimscha, Walter; Przemeck, Michael; Blobner, Manfred; Wulf, Hinnerk; Speek, Marcel; McCrary Sisk, Christine; Williams-Herman, Debora; Woo, Tiffany; Szegedi, Armin

    2014-11-01

    Previous studies show a prolongation of activated partial thromboplastin time and prothrombin time in healthy volunteers after treatment with sugammadex. The authors investigated the effect of sugammadex on postsurgical bleeding and coagulation variables. This randomized, double-blind trial enrolled patients receiving thromboprophylaxis and undergoing hip or knee joint replacement or hip fracture surgery. Patients received sugammadex 4 mg/kg or usual care (neostigmine or spontaneous recovery) for reversal of rocuronium- or vecuronium-induced neuromuscular blockade. The Cochran-Mantel-Haenszel method, stratified by thromboprophylaxis and renal status, was used to estimate relative risk and 95% confidence interval (CI) of bleeding events with sugammadex versus usual care. Safety was further evaluated by prespecified endpoints and adverse event reporting. Of 1,198 patients randomized, 1,184 were treated (sugammadex n = 596, usual care n = 588). Bleeding events within 24 h (classified by an independent, blinded Adjudication Committee) were reported in 17 (2.9%) sugammadex and 24 (4.1%) usual care patients (relative risk [95% CI], 0.70 [0.38 to 1.29]). Compared with usual care, increases of 5.5% in activated partial thromboplastin time (P sugammadex occurred 10 min after administration and resolved within 60 min. There were no significant differences between sugammadex and usual care for other blood loss measures (transfusion, 24-h drain volume, drop in hemoglobin, and anemia), or risk of venous thromboembolism, and no cases of anaphylaxis. Sugammadex produced limited, transient (<1 h) increases in activated partial thromboplastin time and prothrombin time but was not associated with increased risk of bleeding versus usual care.

  19. Ballistic strength training compared with usual care for improving mobility following traumatic brain injury: protocol for a randomised, controlled trial.

    Science.gov (United States)

    Williams, Gavin; Ada, Louise; Hassett, Leanne; Morris, Meg E; Clark, Ross; Bryant, Adam L; Olver, John

    2016-07-01

    Traumatic brain injury is the leading cause of disability in young adults aged 15 to 45 years. Mobility limitations are prevalent, and range in severity from interfering with basic day-to-day tasks to restricting participation in higher level social, leisure, employment and sporting activities. Despite the prevalence and severity of physical impairments, such as poor balance and spasticity, the main contributor to mobility limitations following traumatic brain injury is low muscle power generation. Strengthening exercises that are performed quickly are termed 'ballistic' as they are aimed at improving the rate of force production and, hence, muscle power. This is compared with conventional strength training, which is performed slowly and aims to improve maximum force production, yet has limited impact on mobility. In people recovering from traumatic brain injury: (1) is a 12-week ballistic strength-training program targeting the three muscle groups critical for walking more effective than usual care at improving mobility, strength and balance; and (2) does improved mobility translate to better health-related quality of life? A prospective, multi-centre, randomised, single-blind trial with concealed allocation will be conducted. Participants will be patients with a neurologically based movement disorder affecting mobility as a result of traumatic brain injury. Patients will be recruited during the acute phase of rehabilitation (n=166), from brain injury units in large metropolitan hospitals in Melbourne and Sydney, Australia. For 12 weeks, participants in the experimental group will have three 60-minute sessions of usual physiotherapy intervention replaced by three 60-minute sessions of strength training (ballistic strength, gait). The three key muscle groups responsible for forward propulsion will be targeted: ankle plantarflexors, hip flexors and the hip extensors. Initial loads will be low, to facilitate high contraction velocities. Progression to higher loads

  20. How Do Health Care Providers Diagnose Turner Syndrome?

    Science.gov (United States)

    ... Email Print How do health care providers diagnose Turner syndrome? Health care providers use a combination of physical ... the X chromosomes is partially or completely missing. Turner syndrome also can be diagnosed during pregnancy by testing ...

  1. How Do Health Care Providers Diagnose Cushing's Syndrome?

    Science.gov (United States)

    ... Email Print How do health care providers diagnose Cushing syndrome? Diagnosing Cushing syndrome can be complex and difficult. This syndrome is ... health care provider may try different tests. Diagnosing Cushing syndrome often requires several steps. If you are being ...

  2. Comprehensive Care For Joint Replacement Model - Provider Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — Comprehensive Care for Joint Replacement Model - provider data. This data set includes provider data for two quality measures tracked during an episode of care:...

  3. The third Symptom Management Research Trial in Oncology (SMaRT Oncology-3: a randomised trial to determine the efficacy of adding a complex intervention for major depressive disorder (Depression Care for People with Lung Cancer to usual care, compared to usual care alone in patients with lung cancer

    Directory of Open Access Journals (Sweden)

    Sharpe Michael

    2009-09-01

    Full Text Available Abstract Background Depression Care for People with Lung Cancer is a complex intervention delivered by specially trained cancer nurses, under the supervision of a psychiatrist. It is given as a supplement to the usual care for depression, which patients receive from their general practitioner and cancer service. The third Symptom Management Research Trial in Oncology (SMaRT Oncology-3 Trial will test its efficacy when compared to usual care alone. Design A two arm parallel group multi-centre randomised controlled trial. 200 patients will be recruited through established systematic Symptom Monitoring Services, which screen patients for depression. Patients will have: a diagnosis of lung cancer; an estimated life expectancy of three months or more and a diagnosis of Major Depressive Disorder. Patients will be randomised to usual care or usual care plus Depression Care for People with Lung Cancer. Randomisation will be carried out by telephoning a secure computerised central randomisation system or by using a secure web interface. The primary outcome measure is average depression severity. This will be assessed using scores on the 20-item Symptom Hopkins Checklist (SCL-20D, collected every four weeks over 32 weeks. Secondary outcomes include severity of anxiety, pain and fatigue; self-rated improvement of depression; quality of life and satisfaction with depression care. Trial Registration Current controlled trials ISRCTN75905964

  4. Data governance for health care providers.

    Science.gov (United States)

    Andronis, Katerina; Moysey, Kevin

    2013-01-01

    Data governance is characterised from broader definitions of governance. These characteristics are then mapped to a framework that provides a practical representation of the concepts. This representation is further developed with operating models and roles. Several information related scenarios covering both clinical and non-clinical domains are considered in information terms and then related back to the data governance framework. This assists the reader in understanding how data governance would help address the issues or achieve a better outcome. These elements together enable the reader to gain an understanding of the data governance framework and how it applies in practice. Finally, some practical advice is offered for establishing and operating data governance as well as approaches for justifying the investment.

  5. A randomized controlled trial on early physiotherapy intervention versus usual care in acute care unit for elderly: potential benefits in light of dietary intakes.

    Science.gov (United States)

    Blanc-Bisson, C; Dechamps, A; Gouspillou, G; Dehail, P; Bourdel-Marchasson, I

    2008-01-01

    To evaluate effects of early intensive physiotherapy during acute illness on post hospitalization activity daily living autonomy (ADL). Prospective randomized controlled trial of intensive physiotherapy rehabilitation on day 1 to 2 after admission until clinical stability or usual care. acute care geriatric medicine ward. A total of 76 acutely ill patients, acutely bedridden or with reduced mobility but who were autonomous for mobility within the previous 3 months. Patients in palliative care or with limiting mobility pathology were excluded. Mean age was 85.4 (SD 6.6) years. At admission, at clinical stability and one month later: anthropometry, energy and protein intakes, hand grip strength, ADL scores, and baseline inflammatory parameters. An exploratory principal axis analysis was performed on the baseline characteristics and general linear models were used to explore the course of ADL and nutritional variables. A 4-factor solution was found explaining 71.7% of variance with a factor "nutrition", a factor "function" (18.8% of variance) for ADL, handgrip strength, bedridden state, energy and protein intakes, serum albumin and C-reactive protein concentrations; a factor "strength" and a fourth factor . During follow-up, dietary intakes, handgrip strength, and ADL scores improved but no changes occurred for anthropometric variables. Intervention was associated only with an increase in protein intake. Better improvement in ADL was found in intervention group when model was adjusted on "function" factor items. Physical intervention programs should be proposed according to nutritional intakes with the aim of preventing illness induced disability.

  6. Early rehabilitation after total knee replacement surgery: a multicenter, noninferiority, randomized clinical trial comparing a home exercise program with usual outpatient care.

    Science.gov (United States)

    Han, Annie S Y; Nairn, Lillias; Harmer, Alison R; Crosbie, Jack; March, Lyn; Parker, David; Crawford, Ross; Fransen, Marlene

    2015-02-01

    To determine, at 6 weeks postsurgery, if a monitored home exercise program (HEP) is not inferior to usual care rehabilitation for patients undergoing primary unilateral total knee replacement (TKR) surgery for osteoarthritis. We conducted a multicenter, randomized clinical trial. Patients ages 45-75 years were allocated at the time of hospital discharge to usual care rehabilitation (n = 196) or the HEP (n = 194). Outcomes assessed 6 weeks after surgery included the Western Ontario and McMaster Universities Osteoarthritis Index pain and physical function subscales, knee range of motion, and the 50-foot walk time. The upper bound of the 95% confidence interval (95% CI) mean difference favoring usual care was used to determine noninferiority. At 6 weeks after surgery there were no significant differences between usual care and HEP, respectively, for pain (7.4 and 7.2; 95% CI mean difference [MD] -0.7, 0.9), physical function (22.5 and 22.4; 95% CI MD -2.5, 2.6), knee flexion (96° and 97°; 95% CI MD -4°, 2°), knee extension (-7° and -6°; 95% CI MD -2°, 1°), or the 50-foot walk time (12.9 and 12.9 seconds; 95% CI MD -0.8, 0.7 seconds). At 6 weeks, 18 patients (9%) allocated to usual care and 11 (6%) to the HEP did not achieve 80° knee flexion. There was no difference between the treatment allocations in the number of hospital readmissions. The HEP was not inferior to usual care as an early rehabilitation protocol after primary TKR. Copyright © 2015 by the American College of Rheumatology.

  7. How the psychosocial context of clinical trials differs from usual care: A qualitative study of acupuncture patients

    Directory of Open Access Journals (Sweden)

    White Peter

    2011-05-01

    Full Text Available Abstract Background Qualitative studies of participants' experiences in randomised clinical trials (RCTs suggest that the psychosocial context of treatment in RCTs may be quite different to the psychosocial context of treatment in usual practice. This is important, as the psychosocial context of treatment is known to influence patient outcomes in chronic illness. Few studies have directly compared the psychosocial context of treatment across RCTs and usual practice. In this study, we explored differences in psychosocial context between RCT and usual practice settings, using acupuncture as our model. Methods We undertook a secondary analysis of existing qualitative interviews with 54 patients. 27 were drawn from a study of western and traditional acupuncture in usual practice (for a range of painful conditions. 27 were drawn from a qualitative study nested in an RCT of western acupuncture for osteoarthritis of the hip or knee. We used qualitative analysis software to facilitate an inductive thematic analysis in which we identified three main themes. Results In usual practice, starting acupuncture was more likely to be embedded in an active and ongoing search for pain relief, whereas in the RCT starting acupuncture was opportunistic. Usual practice patients reported few uncertainties and these had minimal consequences for them. In the RCT, patients experienced considerable uncertainties about their treatment and its effectiveness, and were particularly concerned about whether they were receiving real (or fake acupuncture. Patients stopped acupuncture only at the end of the fixed course of treatment in the RCT, which was similar to those receiving acupuncture in the public sector National Health Service (NHS. In comparison, private sector patients re-evaluated and re-negotiated treatments particularly when starting to use acupuncture. Conclusions Differences in psychosocial context between RCTs and usual practice could reduce the impact of

  8. Nurse home visits with or without alert buttons versus usual care in the frail elderly: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Favela J

    2013-01-01

    Full Text Available Jesús Favela,1 Luis A Castro,2 Francisco Franco-Marina,3 Sergio Sánchez-García,4 Teresa Juárez-Cedillo,4 Claudia Espinel Bermudez,4 Julia Mora-Altamirano,4 Marcela D Rodriguez,5 Carmen García-Peña41Center for Scientific Research and Higher Education of Ensenada, Ensenada, Baja California, Mexico; 2Sonora Institute of Technology, Ciudad Obregon, Mexico; 3National Institute of Respiratory Diseases, Mexican Ministry of Health, Mexico City, Mexico; 4Epidemiologic and Health Service Research Unit, Aging Area, XXI Century National Medical Center, Mexican Institute of Social Security, Mexico City, Mexico; 5School of Engineering, MyDCI, Autonomous University of Baja California, Mexicali, MexicoObjective: To assess whether an intervention based on nurse home visits including alert buttons (NV+AB is effective in reducing frailty compared to nurse home visits alone (NV-only and usual care (control group for older adults.Design: Unblinded, randomized, controlled trial.Setting: Insured population covered by the Mexican Social Security Institute living in the city of Ensenada, Baja California, Mexico.Participants: Patients were aged over 60 years with a frailty index score higher than 0.14.Intervention: After screening and informed consent, participants were allocated randomly to the control, NV+AB, or NV-only groups.Measurements: The primary outcome was the frailty score 9 months later. Quality of life, depression, comorbidities, health status, and health service utilization were also considered.Results: The framing sample included 819 patients. Of those, 591 were not located because they did not have a landline/telephone (341 patients, they had died (107, they were ill (50, or they were not currently living in the city (28. A screening interview was applied to 228 participants, and 57 had a score ≤0.14, 171 had ≥0.14, and 16 refused to complete the baseline questionnaire. A home visit was scheduled for 155 patients. However, 22 did not complete

  9. Evaluating wait times from screening to breast cancer diagnosis among women undergoing organised assessment vs usual care.

    Science.gov (United States)

    Chiarelli, Anna M; Muradali, Derek; Blackmore, Kristina M; Smith, Courtney R; Mirea, Lucia; Majpruz, Vicky; O'Malley, Frances P; Quan, May Lynn; Holloway, Claire Mb

    2017-05-09

    Timely coordinated diagnostic assessment following an abnormal screening mammogram reduces patient anxiety and may optimise breast cancer prognosis. Since 1998, the Ontario Breast Screening Program (OBSP) has offered organised assessment through Breast Assessment Centres (BACs). For OBSP women seen at a BAC, an abnormal mammogram is followed by coordinated referrals through the use of navigators for further imaging, biopsy, and surgical consultation as indicated. For OBSP women seen through usual care (UC), further diagnostic imaging is arranged directly from the screening centre and/or through their physician; results must be communicated to the physician who is then responsible for arranging any necessary biopsy and/or surgical consultation. This study aims to evaluate factors associated with diagnostic wait times for women undergoing assessment through BAC and UC. Of the 2 147 257 women aged 50-69 years screened in the OBSP between 1 January 2002 and 31 December 2009, 155 866 (7.3%) had an abnormal mammogram. A retrospective design identified two concurrent cohorts of women diagnosed with screen-detected breast cancer at a BAC (n=4217; 47%) and UC (n=4827; 53%). Multivariable logistic regression analyses examined associations between wait times and assessment and prognostic characteristics by pathway. A two-sided 5% significance level was used. Screened women with breast cancer were two times more likely to be diagnosed within 7 weeks when assessed through a BAC vs UC (OR=1.91, 95% CI=1.73-2.10). In addition, compared with UC, women assessed through a BAC were significantly more likely to have their first assessment procedure within 3 weeks of their abnormal mammogram (OR=1.25, 95% CI=1.12-1.39), ⩽3 assessment procedures (OR=1.54, 95% CI=1.41-1.69), ⩽2 assessment visits (OR=1.86, 95% CI=1.70-2.05), and ⩾2 procedures per visit (OR=1.41, 95% CI=1.28-1.55). Women diagnosed through a BAC were also more likely than those in UC to have imaging (OR=1.99, 95

  10. Comparison of group-based outpatient physiotherapy with usual care after total knee replacement: a feasibility study for a randomized controlled trial.

    Science.gov (United States)

    Artz, Neil; Dixon, Samantha; Wylde, Vikki; Marques, Elsa; Beswick, Andrew D; Lenguerrand, Erik; Blom, Ashley W; Gooberman-Hill, Rachael

    2017-04-01

    To evaluate the feasibility of conducting a randomized controlled trial comparing group-based outpatient physiotherapy with usual care in patients following total knee replacement. A feasibility study for a randomized controlled trial. One secondary-care hospital orthopaedic centre, Bristol, UK. A total of 46 participants undergoing primary total knee replacement. The intervention group were offered six group-based exercise sessions after surgery. The usual care group received standard postoperative care. Participants were not blinded to group allocation. Feasibility was assessed by recruitment, reasons for non-participation, attendance, and completion rates of study questionnaires that included the Lower Extremity Functional Scale and Knee Injury and Osteoarthritis Outcome Score. Recruitment rate was 37%. Five patients withdrew or were no longer eligible to participate. Intervention attendance was high (73%) and 84% of group participants reported they were 'very satisfied' with the exercises. Return of study questionnaires at six months was lower in the usual care (75%) than in the intervention group (100%). Mean (standard deviation) Lower Extremity Functional Scale scores at six months were 45.0 (20.8) in the usual care and 57.8 (15.2) in the intervention groups. Recruitment and retention of participants in this feasibility study was good. Group-based physiotherapy was acceptable to participants. Questionnaire return rates were lower in the usual care group, but might be enhanced by telephone follow-up. The Lower Extremity Functional Scale had high responsiveness and completion rates. Using this outcome measure, 256 participants would be required in a full-scale randomized controlled trial.

  11. Find Ryan White HIV/AIDS Medical Care Providers

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Find Ryan White HIV/AIDS Medical Care Providers tool is a locator that helps people living with HIV/AIDS access medical care and related services. Users can...

  12. Effect of lifestyle coaching versus care coordination versus treatment as usual in people with severe mental illness and overweight

    DEFF Research Database (Denmark)

    Jakobsen, Ane Storch; Speyer, Helene; Nørgaard, Hans Christian Brix

    2017-01-01

    as usual group (P = 0.24). Also, there were no intervention effects for any secondary or exploratory outcomes, including cardiorespiratory fitness, weight, physical activity, diet and smoking. No reported adverse events could be ascribed to the intervention. We conclude that there was neither any direct...

  13. Providing quality nutrition care in acute care hospitals: perspectives of nutrition care personnel.

    Science.gov (United States)

    Keller, H H; Vesnaver, E; Davidson, B; Allard, J; Laporte, M; Bernier, P; Payette, H; Jeejeebhoy, K; Duerksen, D; Gramlich, L

    2014-04-01

    Malnutrition is common in acute care hospitals worldwide and nutritional status can deteriorate during hospitalisation. The aim of the present qualitative study was to identify enablers and challenges and, specifically, the activities, processes and resources, from the perspective of nutrition care personnel, required to provide quality nutrition care. Eight hospitals participating in the Nutrition Care in Canadian Hospitals study provided focus group data (n = 8 focus groups; 91 participants; dietitians, dietetic interns, diet technicians and menu clerks), which were analysed thematically. Five themes emerged from the data: (i) developing a nutrition culture, where nutrition practice is considered important to recovery of patients and teams work together to achieve nutrition goals; (ii) using effective tools, such as screening, evidence-based protocols, quality, timely and accurate patient information, and appropriate and quality food; (iii) creating effective systems to support delivery of care, such as communications, food production and delivery; (iv) being responsive to care needs, via flexible food systems, appropriate menus and meal supplements, up to date clinical care and including patient and family in the care processes; and (v) uniting the right person with the right task, by delineating roles, training staff, providing sufficient time to undertake these important tasks and holding staff accountable for their care. The findings of the present study are consistent with other work and provide guidance towards improving the nutrition culture in hospitals. Further empirical work on how to support successful implementation of nutrition care processes is needed. © 2013 The British Dietetic Association Ltd.

  14. Effectiveness of a transdiagnostic internet-based protocol for the treatment of emotional disorders versus treatment as usual in specialized care: study protocol for a randomized controlled trial.

    Science.gov (United States)

    González-Robles, Alberto; García-Palacios, Azucena; Baños, Rosa; Riera, Antonio; Llorca, Ginés; Traver, Francisco; Haro, Gonzalo; Palop, Vicente; Lera, Guillem; Romeu, José Enrique; Botella, Cristina

    2015-10-31

    Emotional disorders (depression and anxiety disorders) are highly prevalent mental health problems. Although evidence showing the effectiveness of disorder-specific treatments exists, high comorbidity rates among emotional disorders limit the utility of these protocols. This has led some researchers to focus their interest on transdiagnostic interventions, a treatment perspective that might be more widely effective across these disorders. Also, the current way of delivering treatments makes it difficult provide assistance to all of the population in need. The use of the Internet in the delivery of evidence-based treatments may help to disseminate treatments among the population. In this study, we aim to test the effectiveness of EmotionRegulation, a new transdiagnostic Internet-based protocol for unipolar mood disorders, five anxiety disorders (panic disorder, agoraphobia, social anxiety disorder, generalized anxiety disorder and anxiety disorder not otherwise specified), and obsessive-compulsive disorder in comparison to treatment as usual as provided in Spanish public specialized mental health care. We will also study its potential impact on basic temperament dimensions (neuroticism/behavioral inhibition and extraversion/behavioral activation). Expectations and opinions of patients about this protocol will also be studied. The study is a randomized controlled trial. 200 participants recruited in specialized care will be allocated to one of two treatment conditions: a) EmotionRegulation or b) treatment as usual. Primary outcome measures will be the BAI and the BDI-II. Secondary outcomes will include a specific measure of the principal disorder, and measures of neuroticism/behavioral inhibition and extraversion/behavioral activation. Patients will be assessed at baseline, post-treatment, and 3- and 12-month follow-ups. Intention to treat and per protocol analyses will be performed. Although the effectiveness of face-to-face transdiagnostic protocols has been

  15. Self-reported frequency of nurse-provided spiritual care.

    Science.gov (United States)

    Taylor, Elizabeth Johnston; Mamier, Iris; Ricci-Allegra, Patricia; Foith, Joanne

    2017-06-01

    To describe how frequently RNs provide 17 spiritual care therapeutics (or interventions) during a 72-80h timeframe. Plagued by conceptual muddiness as well as weak methods, research quantifying the frequency of spiritual care is not only methodologically limited, but also sparse. Secondary analysis of data from four studies that used the Nurse Spiritual Care Therapeutics Scale (NSCTS). Data from US American RNs who responded to online surveys about spiritual care were analyzed. The four studies included intensive care unit nurses in Ohio (n=93), hospice and palliative care nurses across the US (n=104), nurses employed in a Christian health care system (n=554), and nurses responding to an invitation to participate found on a journal website (n=279). The NSCTS mean of 38 (with a range from 17 to 79 [of 85 possible]) suggested respondents include spiritual care therapeutics infrequently in their nursing care. Particularly concerning is the finding that 17-33% (depending on NSCTS item) never completed a spiritual screening during the timeframe. "Remaining present just to show caring" was the most frequent therapeutic (3.4 on a 5-point scale); those who practiced presence at least 12 times during the timeframe provided other spiritual care therapeutics more frequently than those who offered presence less frequently. Findings affirm previous research that suggests nurses provide spiritual care infrequently. These findings likely provide the strongest evidence yet for the need to improve spiritual care education and support for nurses. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Effects of structured versus usual care on renal endpoint in type 2 diabetes: the SURE study: a randomized multicenter translational study.

    Science.gov (United States)

    Chan, Juliana C; So, Wing-Yee; Yeung, Chun-Yip; Ko, Gary T; Lau, Ip-Tim; Tsang, Man-Wo; Lau, Kam-Piu; Siu, Sing-Chung; Li, June K; Yeung, Vincent T; Leung, Wilson Y; Tong, Peter C

    2009-06-01

    Multifaceted care has been shown to reduce mortality and complications in type 2 diabetes. We hypothesized that structured care would reduce renal complications in type 2 diabetes. A total of 205 Chinese type 2 diabetic patients from nine public hospitals who had plasma creatinine levels of 150-350 micromol/l were randomly assigned to receive structured care (n = 104) or usual care (n = 101) for 2 years. The structured care group was managed according to a prespecified protocol with the following treatment goals: blood pressure triglyceride 500 micromol/l or dialysis). Of these 205 patients (mean +/- SD age 65 +/- 7.2 years; disease duration 14 +/- 7.9 years), the structured care group achieved better control than the usual care group (diastolic blood pressure 68 +/- 12 vs. 71 +/- 12 mmHg, respectively, P = 0.02; A1C 7.3 +/- 1.3 vs. 8.0 +/- 1.6%, P structured care (23.1%, n = 24) and usual care (23.8%, n = 24; NS) groups had similar end points, but more patients in the structured care group attained >or=3 treatment goals (61%, n = 63, vs. 28%, n = 28; P or=3 treatment targets (n = 91) had reduced risk of the primary end point (14 vs. 34; relative risk 0.43 [95% CI 0.21-0.86] compared with that of those who attained

  17. The 'carry-over' effects of patient self-testing: positive effects on usual care management by an anticoagulation management service.

    LENUS (Irish Health Repository)

    Ryan, Fiona

    2010-11-01

    Patient self-testing (PST) of the international normalised ratio (INR) has a positive effect on anticoagulation control. This study investigated whether the benefits of PST (other than increased frequency of testing, e.g. patient education, empowerment, compliance etc.) could be \\'carried-over\\' into usual care management after a period of home-testing has ceased.

  18. Mindfulness-based stress reduction added to care as usual for lung cancer patients and/or their partners: A multicentre randomized controlled trial

    NARCIS (Netherlands)

    Schellekens, M.P.J.; Hurk, D.G.M. van den; Prins, J.B.; Donders, A.R.T.; Molema, J.; Dekhuijzen, R.; Drift, M.A. van der; Speckens, A.E.M.

    2017-01-01

    OBJECTIVE: Lung cancer patients report among the highest distress rates of all cancer patients. Partners report similar distress rates. The present study examined the effectiveness of additional mindfulness-based stress reduction (care as usual [CAU] + MBSR) versus solely CAU to reduce psychological

  19. Preoperative home-based physical therapy versus usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: A pilot randomized controlled trial

    NARCIS (Netherlands)

    Oosting, E.; Jans, M.P.; Dronkers, J.J.; Naber, R.H.; Dronkers-Landman, C.M.; Appelman-De Vries, S.M.; Meeteren, N.L. van

    2012-01-01

    Preoperative home-based physical therapy versus usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: a pilot randomized controlled trial. Objective: To investigate the feasibility and preliminary effectiveness of a home-based intensive exercise

  20. Cognitive-Behavioral Therapy versus Usual Clinical Care for Youth Depression: An Initial Test of Transportability to Community Clinics and Clinicians

    Science.gov (United States)

    Weisz, John R.; Southam-Gerow, Michael A.; Gordis, Elana B.; Connor-Smith, Jennifer K.; Chu, Brian C.; Langer, David A.; McLeod, Bryce D.; Jensen-Doss, Amanda; Updegraff, Alanna; Weiss, Bahr

    2009-01-01

    Community clinic therapists were randomized to (a) brief training and supervision in cognitive-behavioral therapy (CBT) for youth depression or (b) usual care (UC). The therapists treated 57 youths (56% girls), ages 8-15, of whom 33% were Caucasian, 26% were African American, and 26% were Latino/Latina. Most youths were from low-income families…

  1. Behavioural graded activity results in better exercise adherence and more physical activity than usual care in people with osteoarthritis: a cluster-randomised trial

    NARCIS (Netherlands)

    Pisters, M.F.; Veenhof, C.; de Bakker, D.H.; Schellevis, F.G.; Dekker, J.

    2010-01-01

    Question: Does behavioural graded activity result in better exercise adherence and more physical activity than usual care in people with osteoarthritis of the hip or knee? Design: Analysis of secondary outcomes of a cluster-randomised trial with concealed allocation, assessor blinding, and

  2. Effective factors in providing holistic care: a qualitative study.

    Science.gov (United States)

    Zamanzadeh, Vahid; Jasemi, Madineh; Valizadeh, Leila; Keogh, Brian; Taleghani, Fariba

    2015-01-01

    Holistic care is a comprehensive model of caring. Previous studies have shown that most nurses do not apply this method. Examining the effective factors in nurses' provision of holistic care can help with enhancing it. Studying these factors from the point of view of nurses will generate real and meaningful concepts and can help to extend this method of caring. A qualitative study was used to identify effective factors in holistic care provision. Data gathered by interviewing 14 nurses from university hospitals in Iran were analyzed with a conventional qualitative content analysis method and by using MAXQDA (professional software for qualitative and mixed methods data analysis) software. Analysis of data revealed three main themes as effective factors in providing holistic care: The structure of educational system, professional environment, and personality traits. Establishing appropriate educational, management systems, and promoting religiousness and encouragement will induce nurses to provide holistic care and ultimately improve the quality of their caring.

  3. Providing care for critically ill surgical patients: challenges and recommendations.

    Science.gov (United States)

    Tisherman, Samuel A; Kaplan, Lewis; Gracias, Vicente H; Beilman, Gregory J; Toevs, Christine; Byrnes, Matthew C; Coopersmith, Craig M

    2013-07-01

    Providing optimal care for critically ill and injured surgical patients will become more challenging with staff shortages for surgeons and intensivists. This white paper addresses the historical issues behind the present situation, the need for all intensivists to engage in dedicated critical care per the intensivist model, and the recognition that intensivists from all specialties can provide optimal care for the critically ill surgical patient, particularly with continuing involvement by the surgeon of record. The new acute care surgery training paradigm (including trauma, surgical critical care, and emergency general surgery) has been developed to increase interest in trauma and surgical critical care, but the number of interested trainees remains too few. Recommendations are made for broadening the multidisciplinary training and practice opportunities in surgical critical care for intensivists from all base specialties and for maintaining the intensivist model within acute care surgery practice. Support from academic and administrative leadership, as well as national organizations, will be needed.

  4. Immediate interruption of sedation compared with usual sedation care in critically ill postoperative patients (SOS-Ventilation): a randomised, parallel-group clinical trial.

    Science.gov (United States)

    Chanques, Gerald; Conseil, Matthieu; Roger, Claire; Constantin, Jean-Michel; Prades, Albert; Carr, Julie; Muller, Laurent; Jung, Boris; Belafia, Fouad; Cissé, Moussa; Delay, Jean-Marc; de Jong, Audrey; Lefrant, Jean-Yves; Futier, Emmanuel; Mercier, Grégoire; Molinari, Nicolas; Jaber, Samir

    2017-10-01

    Avoidance of excessive sedation and subsequent prolonged mechanical ventilation in intensive care units (ICUs) is recommended, but no data are available for critically ill postoperative patients. We hypothesised that in such patients stopping sedation immediately after admission to the ICU could reduce unnecessary sedation and improve patient outcomes. We did a randomised, parallel-group, clinical trial at three ICUs in France. Stratified randomisation with minimisation (1:1 via a restricted web platform) was used to assign eligible patients (aged ≥18 years, admitted to an ICU after abdominal surgery, and expected to require at least 12 h of mechanical ventilation because of a critical illness defined by a Sequential Organ Failure Assessment score >1 for any organ, but without severe acute respiratory distress syndrome or brain injury) to usual sedation care provided according to recommended practices (control group) or to immediate interruption of sedation (intervention group). The primary outcome was the time to successful extubation (defined as the time from randomisation to the time of extubation [or tracheotomy mask] for at least 48 h). All patients who underwent randomisation (except for those who were excluded after randomisation) were included in the intention-to-treat analysis. This study is registered with ClinicalTrials.gov, number NCT01486121. Between Dec 2, 2011, and Feb 27, 2014, 137 patients were randomly assigned to the control (n=68) or intervention groups (n=69). In the intention-to-treat analysis, time to successful extubation was significantly lower in the intervention group than in the control group (median 8 h [IQR 4-36] vs 50 h [29-93], group difference -33·6 h [95% CI -44·9 to -22·4]; p<0·0001). The adjusted hazard ratio was 5·2 (95% CI 3·1-8·8, p<0·0001). Immediate interruption of sedation in critically ill postoperative patients with organ dysfunction who were admitted to the ICU after abdominal surgery improved outcomes compared

  5. Living well after breast cancer randomized controlled trial protocol: evaluating a telephone-delivered weight loss intervention versus usual care in women following treatment for breast cancer.

    Science.gov (United States)

    Reeves, Marina M; Terranova, Caroline O; Erickson, Jane M; Job, Jennifer R; Brookes, Denise S K; McCarthy, Nicole; Hickman, Ingrid J; Lawler, Sheleigh P; Fjeldsoe, Brianna S; Healy, Genevieve N; Winkler, Elisabeth A H; Janda, Monika; Veerman, J Lennert; Ware, Robert S; Prins, Johannes B; Vos, Theo; Demark-Wahnefried, Wendy; Eakin, Elizabeth G

    2016-10-28

    Obesity, physical inactivity and poor diet quality have been associated with increased risk of breast cancer-specific and all-cause mortality as well as treatment-related side-effects in breast cancer survivors. Weight loss intervention trials in breast cancer survivors have shown that weight loss is safe and achievable; however, few studies have examined the benefits of such interventions on a broad range of outcomes and few have examined factors important to translation (e.g. feasible delivery method for scaling up, assessment of sustained changes, cost-effectiveness). The Living Well after Breast Cancer randomized controlled trial aims to evaluate a 12-month telephone-delivered weight loss intervention (versus usual care) on weight change and a range of secondary outcomes including cost-effectiveness. Women (18-75 years; body mass index 25-45 kg/m 2 ) diagnosed with stage I-III breast cancer in the previous 2 years are recruited from public and private hospitals and through the state-based cancer registry (target n = 156). Following baseline assessment, participants are randomized 1:1 to either a 12-month telephone-delivered weight loss intervention (targeting diet and physical activity) or usual care. Data are collected at baseline, 6-months (mid-intervention), 12-months (end-of-intervention) and 18-months (maintenance). The primary outcome is change in weight at 12-months. Secondary outcomes are changes in body composition, bone mineral density, cardio-metabolic and cancer-related biomarkers, metabolic health and chronic disease risk, physical function, patient-reported outcomes (quality of life, fatigue, menopausal symptoms, body image, fear of cancer recurrence) and behaviors (dietary intake, physical activity, sitting time). Data collected at 18-months will be used to assess whether outcomes achieved at end-of-intervention are sustained six months after intervention completion. Cost-effectiveness will be assessed, as will mediators and moderators of

  6. The effects of immunotherapy with intravenous immunoglobulins versus no intervention, placebo, or usual care in patients with recurrent miscarriages

    DEFF Research Database (Denmark)

    Egerup, Pia; Lindschou, Jane; Gluud, Christian

    2014-01-01

    , and publication status investigating infusions with immunoglobulins in relation to pregnancy compared to placebo, no intervention, or treatment as usual for assessments of benefits and harms. The relevant published literature will be searched using the following databases: Cochrane Central Register of Controlled...... Trials, Medline, Embase, WHO International Clinical Trials Registry Platform, and Ovid Medline In-Process and Other Non-Indexed Citations databases. Two review authors will independently extract data and assess risk of bias. We will undertake meta-analyses according to the recommendations stated...

  7. Electronic consultation system demonstrates educational benefit for primary care providers.

    Science.gov (United States)

    Kwok, Jonas; Olayiwola, J Nwando; Knox, Margae; Murphy, Elizabeth J; Tuot, Delphine S

    2017-01-01

    Background Electronic consultation systems allow primary care providers to receive timely speciality expertise via iterative electronic communication. The use of such systems is expanding across the USA with well-documented high levels of user satisfaction. We characterise the educational impact for primary care providers of a long-standing integrated electronic consultation and referral system. Methods Primary care providers' perceptions of the educational value inherent to electronic consultation system communication and the impact on their ability to manage common speciality clinical conditions and questions were examined by electronic survey using five-point Likert scales. Differences in primary care providers' perceptions were examined overall and by primary care providers' speciality, provider type and years of experience. Results Among 221 primary care provider participants (35% response rate), 83.9% agreed or strongly agreed that the integrated electronic consultation and referral system provided educational value. There were no significant differences in educational value reported by provider type (attending physician, mid-level provider, or trainee physician), primary care providers' speciality, or years of experience. Perceived benefit of the electronic consultation and referral system in clinical management appeared stronger for laboratory-based conditions (i.e. subclinical hypothyroidism) than more diffuse conditions (i.e. abdominal pain). Nurse practitioners/physician assistants and trainee physicians were more likely to report improved abilities to manage specific clinical conditions when using the electronic consultation and/or referral system than were attending physicians, as were primary care providers with ≤10 years experience, versus those with >20 years of experience. Conclusions Primary care providers report overwhelmingly positive perceptions of the educational value of an integrated electronic consultation and referral system. Nurse

  8. Modeling Market Shares of Competing (e)Care Providers

    Science.gov (United States)

    van Ooteghem, Jan; Tesch, Tom; Verbrugge, Sofie; Ackaert, Ann; Colle, Didier; Pickavet, Mario; Demeester, Piet

    In order to address the increasing costs of providing care to the growing group of elderly, efficiency gains through eCare solutions seem an obvious solution. Unfortunately not many techno-economic business models to evaluate the return of these investments are available. The construction of a business case for care for the elderly as they move through different levels of dependency and the effect of introducing an eCare service, is the intended application of the model. The simulation model presented in this paper allows for modeling evolution of market shares of competing care providers. Four tiers are defined, based on the dependency level of the elderly, for which the market shares are determined. The model takes into account available capacity of the different care providers, in- and outflow distribution between tiers and churn between providers within tiers.

  9. Primary care providers' experiences caring for complex patients in primary care: a qualitative study.

    Science.gov (United States)

    Loeb, Danielle F; Bayliss, Elizabeth A; Candrian, Carey; deGruy, Frank V; Binswanger, Ingrid A

    2016-03-22

    Complex patients are increasingly common in primary care and often have poor clinical outcomes. Healthcare system barriers to effective care for complex patients have been previously described, but less is known about the potential impact and meaning of caring for complex patients on a daily basis for primary care providers (PCPs). Our objective was to describe PCPs' experiences providing care for complex patients, including their experiences of health system barriers and facilitators and their strategies to enhance provision of effective care. Using a general inductive approach, our qualitative research study was guided by an interpretive epistemology, or way of knowing. Our method for understanding included semi-structured in-depth interviews with internal medicine PCPs from two university-based and three community health clinics. We developed an interview guide, which included questions on PCPs' experiences, perceived system barriers and facilitators, and strategies to improve their ability to effectively treat complex patients. To focus interviews on real cases, providers were asked to bring de-identified clinical notes from patients they considered complex to the interview. Interview transcripts were coded and analyzed to develop categories from the raw data, which were then conceptualized into broad themes after team-based discussion. PCPs (N = 15) described complex patients with multidimensional needs, such as socio-economic, medical, and mental health. A vision of optimal care emerged from the data, which included coordinating care, preventing hospitalizations, and developing patient trust. PCPs relied on professional values and individual care strategies to overcome local and system barriers. Team based approaches were endorsed to improve the management of complex patients. Given the barriers to effective care described by PCPs, individual PCP efforts alone are unlikely to meet the needs of complex patients. To fulfill PCP's expressed concepts of

  10. 'Pragmatic randomized controlled trial of individually prescribed exercise versus usual care in a heterogeneous cancer survivor population': a feasibility study PEACH trial: prescribed exercise after chemotherapy.

    LENUS (Irish Health Repository)

    Walsh, Julie M

    2010-01-01

    BACKGROUND: Many cancer survivors suffer a range of physical and psychological symptoms which may persist for months or years after cessation of treatment. Despite the known benefits of exercise and its potential to address many of the adverse effects of treatment, the role of exercise as well as optimum duration, frequency, and intensity in this population has yet to be fully elucidated. Many cancer rehabilitation programmes presented in the literature are very long and have tight eligibility criteria which make them non-applicable to the majority of cancer survivors. This paper presents the protocol of a novel 8-week intervention which aims to increase fitness, and address other physical symptoms in a heterogeneous cancer survivor population. METHODS\\/DESIGN: The aim is to recruit 64 cancer survivors 2-6 months after completion of chemotherapy, usually adjuvant, with curative intent. Subjects will be recruited through oncology clinics in a single institution and randomised to usual care or an exercise intervention. The exercise intervention consists of two specifically tailored supervised moderate intensity aerobic exercise sessions weekly over 8-weeks. All participants will be assessed at baseline (0 weeks), at the end of the intervention (8 weeks), and at 3-month follow-up. The primary outcome measure is fitness, and secondary patient-related outcome measures include fatigue, quality of life, and morphological outcomes. A further secondary outcome is process evaluation including adherence to and compliance with the exercise program. DISCUSSION: This study will provide valuable information about the physical outcomes of this 8-week supervised aerobic programme. Additionally, process information and economic evaluation will inform the feasibility of implementing this program in a heterogeneous population post cessation of chemotherapy.

  11. Surrogate pregnancy: a guide for Canadian prenatal health care providers

    OpenAIRE

    Reilly, Dan R.

    2007-01-01

    Providing health care for a woman with a surrogate pregnancy involves unique challenges. Although the ethical debate surrounding surrogacy continues, Canada has banned commercial, but not altruistic, surrogacy. In the event of a custody dispute between a surrogate mother and the individual(s) intending to parent the child, it is unclear how Canadian courts would rule. The prenatal health care provider must take extra care to protect the autonomy and privacy rights of the surrogate. There is l...

  12. Physical Profiling Performance of Air Force Primary Care Providers

    Science.gov (United States)

    2017-08-09

    AFRL-SA-WP-TR-2017-0014 Physical Profiling Performance of Air Force Primary Care Providers Anthony P. Tvaryanas1; William P...COVERED (From – To) September 2016 – January 2017 4. TITLE AND SUBTITLE Physical Profiling Performance of Air Force Primary Care Providers...encounter with their primary care team. An independent medical standards subject matter expert (SME) reviewed encounters in the electronic health record

  13. Improving palliative care outcomes for Aboriginal Australians: service providers' perspectives.

    Science.gov (United States)

    Shahid, Shaouli; Bessarab, Dawn; van Schaik, Katherine D; Aoun, Samar M; Thompson, Sandra C

    2013-07-23

    Aboriginal Australians have a lower rate of utilisation of palliative care services than the general population. This study aimed to explore care providers' experiences and concerns in providing palliative care for Aboriginal people, and to identify opportunities for overcoming gaps in understanding between them and their Aboriginal patients and families. In-depth, qualitative interviews with urban, rural and remote palliative care providers were undertaken in inpatient and community settings in Western Australia. Interviews were audio-recorded, transcribed verbatim and coded independently by two researchers with QSR NVivo 10 software used to help manage data. Data analysis was informed by multiple theoretical standpoints, including the social ecological model, critical cultural theories and the 'cultural security' framework. Thematic analysis was carried out that identified patterns within data. Fifteen palliative care providers were interviewed. Overall they reported lack of understanding of Aboriginal culture and being uncertain of the needs and priorities of Aboriginal people during end-of-life care. According to several participants, very few Aboriginal people had an understanding of palliative care. Managing issues such as anger, denial, the need for non-medical support due to socioeconomic disadvantage, and dealing with crises and conflicts over funeral arrangements were reported as some of the tensions between Aboriginal patients and families and the service providers. Early referral to palliative care is important in demonstrating and maintaining a caring therapeutic relationship. Paramount to meeting the needs for Aboriginal patients was access to appropriate information and logistical, psychological and emotional support. These were often seen as essential but additional to standard palliative care services. The broader context of Aboriginal history and historical distrust of mainstream services was seen to impinge on Aboriginal people's willingness and

  14. Maternity Care Services Provided by Family Physicians in Rural Hospitals.

    Science.gov (United States)

    Young, Richard A

    The purpose of this study was to describe how many rural family physicians (FPs) and other types of providers currently provide maternity care services, and the requirements to obtain privileges. Chief executive officers of rural hospitals were purposively sampled in 15 geographically diverse states with significant rural areas in 2013 to 2014. Questions were asked about the provision of maternity care services, the physicians who perform them, and qualifications required to obtain maternity care privileges. Analysis used descriptive statistics, with comparisons between the states, community rurality, and hospital size. The overall response rate was 51.2% (437/854). Among all identified hospitals, 44.9% provided maternity care services, which varied considerably by state (range, 17-83%; P maternity care, a mean of 271 babies were delivered per year, 27% by cesarean delivery. A mean of 7.0 FPs had privileges in these hospitals, of which 2.8 provided maternity care and 1.8 performed cesarean deliveries. The percentage of FPs who provide maternity care (mean, 48%; range, 10-69%; P maternity care who are FPs (mean, 63%; range, 10-88%; P maternity care services in US rural hospitals, including cesarean deliveries. Some family medicine residencies should continue to train their residents to provide these services to keep replenishing this valuable workforce. © Copyright 2017 by the American Board of Family Medicine.

  15. 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…

  16. Providing general and preconception health care to low income women in family planning settings: perception of providers and clients.

    Science.gov (United States)

    Bronstein, Janet M; Felix, Holly C; Bursac, Zoran; Stewart, M Kathryn; Foushee, H Russell; Klapow, Joshua

    2012-02-01

    This study examines both provider and client perceptions of the extent to which general health concerns are addressed in the context of publicly supported family planning care. A mail survey of family planning providers (n = 459) accepting Medicaid-covered clients in Arkansas and Alabama gathered data on reported actions and resource referral availability for ten categories of non-contraceptive health concerns. A telephone survey of recent family planning clients of these providers (n = 1991) gathered data on the presence of 16 health concerns and whether and how they were addressed by the family planning provider. Data were collected in 2006-2007. More than half (56%) of clients reported having one or more general health concerns. While 43% of those concerns had been discussed with the family planning providers, only 8% had been originally identified by these providers. Women with higher trust in physicians and usual sources of general health care were more likely to discuss their concerns. Of those concerns discussed, 39% were reportedly treated by the family planning provider. Similarly, over half of responding providers reported providing treatment for acute and chronic health conditions and counseling on health behaviors during family planning visits. Lack of familiarity with referral resources for uninsured clients was identified as a significant concern in the provision of care to these clients. Greater engagement by providers in identifying client health concerns and better integration of publicly supported family planning with other sources of health care for low income women could expand the existing potential for delivering preconception or general health care in these settings.

  17. The feasibility of a randomised controlled trial to compare the cost-effectiveness of palliative cardiology or usual care in people with advanced heart failure: Two exploratory prospective cohorts.

    Science.gov (United States)

    Johnson, Miriam J; McSkimming, Paula; McConnachie, Alex; Geue, Claudia; Millerick, Yvonne; Briggs, Andrew; Hogg, Karen

    2018-06-01

    The effectiveness of cardiology-led palliative care is unknown; we have insufficient information to conduct a full trial. To assess the feasibility (recruitment/retention, data quality, variability/sample size estimation, safety) of a clinical trial of palliative cardiology effectiveness. Non-randomised feasibility. Unmatched symptomatic heart failure patients on optimal cardiac treatment from (1) cardiology-led palliative service (caring together group) and (2) heart failure liaison service (usual care group). Outcomes/safety: Symptoms (Edmonton Symptom Assessment Scale), Kansas City Cardiomyopathy Questionnaire, performance, understanding of disease, anticipatory care planning, cost-effectiveness, survival and carer burden. A total of 77 participants (caring together group = 43; usual care group = 34) were enrolled (53% men; mean age 77 years (33-100)). The caring together group scored worse in Edmonton Symptom Assessment Scale (43.5 vs 35.2) and Kansas City Cardiomyopathy Questionnaire (35.4 vs 39.9). The caring together group had a lower consent/screen ratio (1:1.7 vs 1: 2.8) and few died before approach (0.08% vs 16%) or declined invitation (17% vs 37%). Data quality: At 4 months, 74% in the caring together group and 71% in the usual care group provided data. Most attrition was due to death or deterioration. Data quality in self-report measures was otherwise good. There was no difference in survival. Symptoms and quality of life improved in both groups. A future trial requires 141 (202 allowing 30% attrition) to detect a minimal clinical difference (1 point) in Edmonton Symptom Assessment Scale score for breathlessness (80% power). More participants (176; 252 allowing 30% attrition) are needed to detect a 10.5 change in Kansas City Cardiomyopathy Questionnaire score (80% power; minimum clinical difference = 5). A trial to test the clinical effectiveness (improvement in breathlessness) of cardiology-led palliative care is feasible.

  18. Economic evaluation of Internet-based problem-solving guided self-help treatment in comparison with enhanced usual care for depressed outpatients waiting for face-to-face treatment: A randomized controlled trial.

    Science.gov (United States)

    Kolovos, Spyros; Kenter, Robin M F; Bosmans, Judith E; Beekman, Aartjan T F; Cuijpers, Pim; Kok, Robin N; van Straten, Annemieke

    2016-08-01

    Previous studies have demonstrated the effectiveness of Internet-based interventions for depression in comparison with usual care. However, evidence on the cost-effectiveness of these interventions when delivered in outpatient clinics is lacking. The aim of this study was to estimate the cost-effectiveness of an Internet-based problem-solving guided self-help intervention in comparison with enhanced usual care for outpatients on a waiting list for face-to-face treatment for major depression. After the waiting list period, participants from both groups received the same treatment at outpatient clinics. An economic evaluation was performed alongside a randomized controlled trial with 12 months follow-up. Outcomes were improvement in depressive symptom severity (measured by CES-D), response to treatment and Quality-Adjusted Life-Years (QALYs). Statistical uncertainty around cost differences and incremental cost-effectiveness ratios were estimated using bootstrapping. Mean societal costs for the intervention group were €1579 higher than in usual care, but this was not statistically significant (95% CI - 1395 to 4382). Cost-effectiveness acceptability curves showed that the maximum probability of the intervention being cost-effective in comparison with usual care was 0.57 at a ceiling ratio of €15,000/additional point of improvement in CES-D, and 0.25 and 0.30 for an additional response to treatment and an extra QALY respectively, at a ceiling ratio of €30,000. Sensitivity analysis showed that from a mental healthcare provider perspective the probability of the intervention being cost-effective was 0.68 for a ceiling ratio of 0 €/additional unit of effect for the CES-D score, response to treatment and QALYs. As the ceiling ratio increased this probability decreased, because the mean costs in the intervention group were lower than the mean costs in the usual care group. The patients in the intervention group showed low adherence to the Internet-based treatment

  19. Provider-to-Provider Communication during Transitions of Care from Outpatient to Acute Care: A Systematic Review.

    Science.gov (United States)

    Luu, Ngoc-Phuong; Pitts, Samantha; Petty, Brent; Sawyer, Melinda D; Dennison-Himmelfarb, Cheryl; Boonyasai, Romsai Tony; Maruthur, Nisa M

    2016-04-01

    Most research on transitions of care has focused on the transition from acute to outpatient care. Little is known about the transition from outpatient to acute care. We conducted a systematic review of the literature on the transition from outpatient to acute care, focusing on provider-to-provider communication and its impact on quality of care. We searched the MEDLINE, CINAHL, Scopus, EMBASE, and Cochrane databases for English-language articles describing direct communication between outpatient providers and acute care providers around patients presenting to the emergency department or admitted to the hospital. We conducted double, independent review of titles, abstracts, and full text articles. Conflicts were resolved by consensus. Included articles were abstracted using standardized forms. We maintained search results via Refworks (ProQuest, Bethesda, MD). Risk of bias was assessed using a modified version of the Downs' and Black's tool. Of 4009 citations, twenty articles evaluated direct provider-to-provider communication around the outpatient to acute care transition. Most studies were cross-sectional (65%), conducted in the US (55%), and studied communication between primary care and inpatient providers (62%). Of three studies reporting on the association between communication and 30-day readmissions, none found a significant association; of these studies, only one reported a measure of association (adjusted OR for communication vs. no communication, 1.08; 95% CI 0.92-1.26). The literature on provider-to-provider communication at the transition from outpatient to acute care is sparse and heterogeneous. Given the known importance of communication for other transitions of care, future studies are needed on provider-to-provider communication during this transition. Studies evaluating ideal methods for communication to reduce medical errors, utilization, and optimize patient satisfaction at this transition are especially needed.

  20. Treatment of chronically depressed patients: A multisite randomized controlled trial testing the effectiveness of 'Cognitive Behavioral Analysis System of Psychotherapy' (CBASP for chronic depressions versus usual secondary care

    Directory of Open Access Journals (Sweden)

    Penninx Brenda WJH

    2008-03-01

    Full Text Available Abstract Background 'Cognitive Behavioral Analysis System of Psychotherapy' (CBASP is a form of psychotherapy specifically developed for patients with chronic depression. In a study in the U.S., remarkable favorable effects of CBASP have been demonstrated. However, no other studies have as yet replicated these findings and CBASP has not been tested outside the United States. This protocol describes a randomized controlled trial on the effectiveness of CBASP in the Netherlands. Methods/Design The purpose of the present paper is to report the study protocol of a multisite randomized controlled trial testing the effectiveness of 'Cognitive Behavioral Analysis System of Psychotherapy' (CBASP for chronic depression in the Netherlands. In this study, CBASP in combination with medication, will be tested versus usual secondary care in combination with medication. The aim is to recruit 160 patients from three mental health care organizations. Depressive symptoms will be assessed at baseline, after 8 weeks, 16 weeks, 32 weeks and 52 weeks, using the 28-item Inventory for Depressive Symptomatology (IDS. Effect modification by co morbid anxiety, alcohol consumption, general and social functioning and working alliance will be tested. GEE analyses of covariance, controlling for baseline value and center will be used to estimate the overall treatment effectiveness (difference in IDS score at post-treatment and follow up. The primary analysis will be by 'intention to treat' using double sided tests. An economic analysis will compare the two groups in terms of mean costs and cost-effectiveness from a societal perspective. Discussion The study will provide an answer to the question whether the favorable effects of CBASP can be replicated outside the US. Trial Registration The Dutch Cochrane Center, NTR1090.

  1. "The care is the best you can give at the time": Health care professionals' experiences in providing gender affirming care in South Africa.

    Directory of Open Access Journals (Sweden)

    Sarah Spencer

    Full Text Available While the provision of gender affirming care for transgender people in South Africa is considered legal, ethical, and medically sound, and is-theoretically-available in both the South African private and public health sectors, access remains severely limited and unequal within the country. As there are no national policies or guidelines, little is known about how individual health care professionals providing gender affirming care make clinical decisions about eligibility and treatment options.Based on an initial policy review and service mapping, this study employed semi-structured interviews with a snowball sample of twelve health care providers, representing most providers currently providing gender affirming care in South Africa. Data were analysed thematically using NVivo, and are reported following COREQ guidelines.Our findings suggest that, whilst a small minority of health care providers offer gender affirming care, this is almost exclusively on their own initiative and is usually unsupported by wider structures and institutions. The ad hoc, discretionary nature of services means that access to care is dependent on whether a transgender person is fortunate enough to access a sympathetic and knowledgeable health care provider.Accordingly, national, state-sanctioned guidelines for gender affirming care are necessary to increase access, homogenise quality of care, and contribute to equitable provision of gender affirming care in the public and private health systems.

  2. “The care is the best you can give at the time”: Health care professionals’ experiences in providing gender affirming care in South Africa

    Science.gov (United States)

    Spencer, Sarah; Meer, Talia

    2017-01-01

    Background While the provision of gender affirming care for transgender people in South Africa is considered legal, ethical, and medically sound, and is—theoretically—available in both the South African private and public health sectors, access remains severely limited and unequal within the country. As there are no national policies or guidelines, little is known about how individual health care professionals providing gender affirming care make clinical decisions about eligibility and treatment options. Method Based on an initial policy review and service mapping, this study employed semi-structured interviews with a snowball sample of twelve health care providers, representing most providers currently providing gender affirming care in South Africa. Data were analysed thematically using NVivo, and are reported following COREQ guidelines. Results Our findings suggest that, whilst a small minority of health care providers offer gender affirming care, this is almost exclusively on their own initiative and is usually unsupported by wider structures and institutions. The ad hoc, discretionary nature of services means that access to care is dependent on whether a transgender person is fortunate enough to access a sympathetic and knowledgeable health care provider. Conclusion Accordingly, national, state-sanctioned guidelines for gender affirming care are necessary to increase access, homogenise quality of care, and contribute to equitable provision of gender affirming care in the public and private health systems. PMID:28704458

  3. Comparison of Simulated Treatment and Cost-effectiveness of a Stepped Care Case-Finding Intervention vs Usual Care for Posttraumatic Stress Disorder After a Natural Disaster.

    Science.gov (United States)

    Cohen, Gregory H; Tamrakar, Shailesh; Lowe, Sarah; Sampson, Laura; Ettman, Catherine; Linas, Ben; Ruggiero, Kenneth; Galea, Sandro

    2017-12-01

    Psychiatric interventions offered after natural disasters commonly address subsyndromal symptom presentations, but often remain insufficient to reduce the burden of chronic posttraumatic stress disorder (PTSD). To simulate a comparison of a stepped care case-finding intervention (stepped care [SC]) vs a moderate-strength single-level intervention (usual care [UC]) on treatment effectiveness and incremental cost-effectiveness in the 2 years after a natural disaster. This study, which simulated treatment scenarios that start 4 weeks after landfall of Hurricane Sandy on October 29, 2012, and ending 2 years later, created a model of 2 642 713 simulated agents living in the areas of New York City affected by Hurricane Sandy. Under SC, cases were referred to cognitive behavioral therapy, an evidence-based therapy that aims to improve symptoms through problem solving and by changing thoughts and behaviors; noncases were referred to Skills for Psychological Recovery, an evidence-informed therapy that aims to reduce distress and improve coping and functioning. Under UC, all patients were referred only to Skills for Psychological Recovery. The reach of SC compared with UC for 2 years, the 2-year reduction in prevalence of PTSD among the full population, the 2-year reduction in the proportion of PTSD cases among initial cases, and 10-year incremental cost-effectiveness. This population of 2 642 713 simulated agents was initialized with a PTSD prevalence of 4.38% (115 751 cases) and distributions of sex (52.6% female and 47.4% male) and age (33.9% aged 18-34 years, 49.0% aged 35-64 years, and 17.1% aged ≥65 years) that were comparable with population estimates in the areas of New York City affected by Hurricane Sandy. Stepped care was associated with greater reach and was superior to UC in reducing the prevalence of PTSD in the full population: absolute benefit was clear at 6 months (risk difference [RD], -0.004; 95% CI, -0.004 to -0.004), improving through 1

  4. Nurse education and willingness to provide spiritual care.

    Science.gov (United States)

    Wu, Li-Fen; Tseng, Hui-Chen; Liao, Yu-Chen

    2016-03-01

    Spiritual care is a critical part of holistic care, and nurses require adequate preparation to address the spiritual needs of patients. However, nurses' willingness to provide such care has rarely been reported. Hence, nurses' education, and knowledge of spiritual care, as well as their willingness to provide it require further study. A convenience sample of 200 nurses participated in the study. Quantitative data were collected using a 21-item Spiritual Care Needs Inventory (content validity index=.87; Cronbach's alpha=.96). The majority of participants were female (96.5%, n=193) between 21 and 59years old (mean=35.1years). Moreover, the majority of participants had a Bachelor's degree (74.0%, n=148) and 1-36years of clinical experience (mean=12.13years). Regarding religious beliefs, 63 (31.5%) had no religious belief, and 93 (46.5%) did not engage in any religious activity. Overall, the nurses were willing to provide spiritual care, although only 25 (12.5%) felt that they had received adequate education. The findings of this study indicate the need for further educational preparation in spiritual care for nurses. Specifically, additional teaching materials are required that are more directly related to spiritual care. Greater emphasis should be placed on different subject areas in school-based education, continuing education, and self-learning education according to the needs of nurses. Since spiritual care education needs policy support, in-depth discussions should take place regarding the approach and cultural environment for providing spiritual care in future nursing courses. Moreover, further studies should investigate barriers in providing spiritual nursing care to patients and whether they are the results of a lack of relevant knowledge or other factors. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Not the usual suspect: a case of erythema induration of Bazin in an urban primary care clinic

    Directory of Open Access Journals (Sweden)

    Ling Xu

    2015-12-01

    Full Text Available Frontline clinicians in the United States, especially those working in safety net hospitals or with immigrant populations, will likely see cutaneous tuberculosis given the tremendous burden of tuberculosis infection worldwide. The tuberculid is a subtype of cutaneous tuberculosis that poses a diagnostic challenge because organisms are not found in smears or cultures taken from the lesions. Tuberculid lesions can mimic erythema nodosum, thrombophlebitis, and cellulitis. We describe the case of a 57-year-old woman immigrant from China who presented with tender, subcutaneous nodules on her ankle and thigh in the setting of prior exposure to tuberculosis. We describe the clinical, pathophysiologic, and histopathologic features of tuberculids in order to raise awareness among primary care clinicians about this difficult to diagnose but readily treatable manifestation of tuberculosis.

  6. Variability in usual care mechanical ventilation for pediatric acute lung injury: the potential benefit of a lung protective computer protocol.

    Science.gov (United States)

    Khemani, Robinder G; Sward, Katherine; Morris, Alan; Dean, J Michael; Newth, Christopher J L

    2011-11-01

    Although pediatric intensivists claim to embrace lung protective ventilation for acute lung injury (ALI), ventilator management is variable. We describe ventilator changes clinicians made for children with hypoxemic respiratory failure, and evaluate the potential acceptability of a pediatric ventilation protocol. This was a retrospective cohort study performed in a tertiary care pediatric intensive care unit (PICU). The study period was from January 2000 to July 2007. We included mechanically ventilated children with PaO(2)/FiO(2) (P/F) ratio less than 300. We assessed variability in ventilator management by evaluating actual changes to ventilator settings after an arterial blood gas (ABG). We evaluated the potential acceptability of a pediatric mechanical ventilation protocol we adapted from National Institutes of Health/National Heart, Lung, and Blood Institute (NIH/NHLBI) Acute Respiratory Distress Syndrome (ARDS) Network protocols by comparing actual practice changes in ventilator settings to changes that would have been recommended by the protocol. A total of 2,719 ABGs from 402 patients were associated with 6,017 ventilator settings. Clinicians infrequently decreased FiO(2), even when the PaO(2) was high (>68 mmHg). The protocol would have recommended more positive end expiratory pressure (PEEP) than was used in actual practice 42% of the time in the mid PaO(2) range (55-68 mmHg) and 67% of the time in the low PaO(2) range (ventilator rate (VR) when the protocol would have recommended a change, even when the pH was greater than 7.45 with PIP at least 35 cmH(2)O. There may be lost opportunities to minimize potentially injurious ventilator settings for children with ALI. A reproducible pediatric mechanical ventilation protocol could prompt clinicians to make ventilator changes that are consistent with lung protective ventilation.

  7. Environmental Management of Pediatric Asthma: Guidelines for Health Care Providers

    Science.gov (United States)

    Roberts, James R.; McCurdy, Leyla Erk

    2005-01-01

    These guidelines are the product of a new Pediatric Asthma Initiative aimed at integrating environmental management of asthma into pediatric health care. This document outlines competencies in environmental health relevant to pediatric asthma that should be mastered by primary health care providers, and outlines the environmental interventions…

  8. Attitude and practice of health care providers towards autopsies in ...

    African Journals Online (AJOL)

    Background: Attitude and practice of health care professionals toward autopsy are important as they will give information regarding factors that contribute to the low rate of autopsies in children under five years. Objective: To evaluate the attitude and practice of health care providers towards autopsies in children under five ...

  9. The care provided by general practitioners for persistent depression

    NARCIS (Netherlands)

    Van Os, TWDP; Van den Brink, RHS; Van der Meer, K; Ormel, J

    Purpose. - To examine the care provided by general practitioners (GPs) for persistent depressive illness and its relationship to patient, illness and consultation characteristics. Subjects and method. - Using the Composite International Diagnostic Interview-Primary Health Care Version (CIDI-PHC) a

  10. Parents\\' lived experience of providing kangaroo care to their ...

    African Journals Online (AJOL)

    Premature and low birthweight infants pose particular challenges to health services in South Africa. While there is good evidence to demonstrate the benefits of kangaroo care in low birthweight infants, limited research has been conducted locally on the experiences of parents who provide kangaroo care to their preterm ...

  11. Integrating advanced practice providers into medical critical care teams.

    Science.gov (United States)

    McCarthy, Christine; O'Rourke, Nancy C; Madison, J Mark

    2013-03-01

    Because there is increasing demand for critical care providers in the United States, many medical ICUs for adults have begun to integrate nurse practitioners and physician assistants into their medical teams. Studies suggest that such advanced practice providers (APPs), when appropriately trained in acute care, can be highly effective in helping to deliver high-quality medical critical care and can be important elements of teams with multiple providers, including those with medical house staff. One aspect of building an integrated team is a practice model that features appropriate coding and billing of services by all providers. Therefore, it is important to understand an APP's scope of practice, when they are qualified for reimbursement, and how they may appropriately coordinate coding and billing with other team providers. In particular, understanding when and how to appropriately code for critical care services (Current Procedural Terminology [CPT] code 99291, critical care, evaluation and management of the critically ill or critically injured patient, first 30-74 min; CPT code 99292, critical care, each additional 30 min) and procedures is vital for creating a sustainable program. Because APPs will likely play a growing role in medical critical care units in the future, more studies are needed to compare different practice models and to determine the best way to deploy this talent in specific ICU settings.

  12. Diarrhea - what to ask your health care provider - adult

    Science.gov (United States)

    What to ask your health care provider about diarrhea - adult; Loose stools - what to ask your health ... medicines, vitamins, herbs, or supplements I take cause diarrhea? Should I stop taking any of them? What ...

  13. Skin Diseases: Questions for Your Health Care Provider

    Science.gov (United States)

    Skip Navigation Bar Home Current Issue Past Issues Skin Diseases Questions for Your Health Care Provider Past ... dermatitis worse? What are the most common irritants? Skin cancer What type of skin cancer do I ...

  14. How Do Health Care Providers Diagnose Intellectual & Developmental Disabilities (IDDs)?

    Science.gov (United States)

    ... www.nbstrn.org/ or the Centers for Disease Control and Prevention webpage at http://www.cdc.gov/ncbddd/birthdefects/diagnosis.html . Prenatal Screening Health care providers recommend that certain pregnant ...

  15. Choosing the right health care provider for pregnancy and childbirth

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000596.htm Choosing the right health care provider for pregnancy and childbirth To use the sharing features on this page, please enable JavaScript. ...

  16. How Do Health Care Providers Diagnose Klinefelter Syndrome?

    Science.gov (United States)

    ... Email Print How do health care providers diagnose Klinefelter syndrome (KS)? The only way to confirm the presence ... in 166 boys, adolescents and adults with nonmosaic Klinefelter syndrome: A Copenhagen experience. Acta Paediatrica , Jun;100(6), ...

  17. Using the National Provider Identifier for Health Care...

    Data.gov (United States)

    U.S. Department of Health & Human Services — The establishment in recent years of a National Provider Identifier (NPI) offers a new method for counting and categorizing physicians and other health care...

  18. Competence of health care providers on care of newborns at birth in ...

    African Journals Online (AJOL)

    Introduction: This is an observational study which was carried out at a level one health facility in Yaoundé from June to July 2009. The aim was to evaluate the competence of health care providers towards newborns' care at birth. Methods: Ten health care providers took care of three hundred and thirty-five pregnant women ...

  19. Inpatient Massage Therapy Versus Music Therapy Versus Usual Care: A Mixed-methods Feasibility Randomized Controlled Trial.

    Science.gov (United States)

    Roseen, Eric J; Cornelio-Flores, Oscar; Lemaster, Chelsey; Hernandez, Maria; Fong, Calvin; Resnick, Kirsten; Wardle, Jon; Hanser, Suzanne; Saper, Robert

    2017-01-01

    Little is known about the feasibility of providing massage or music therapy to medical inpatients at urban safety-net hospitals or the impact these treatments may have on patient experience. To determine the feasibility of providing massage and music therapy to medical inpatients and to assess the impact of these interventions on patient experience. Single-center 3-arm feasibility randomized controlled trial. Urban academic safety-net hospital. Adult inpatients on the Family Medicine ward. Massage therapy consisted of a standardized protocol adapted from a previous perioperative study. Music therapy involved a preference assessment, personalized compact disc, music-facilitated coping, singing/playing music, and/or songwriting. Credentialed therapists provided the interventions. Patient experience was measured with the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) within 7 days of discharge. We compared the proportion of patients in each study arm reporting "top box" scores for the following a priori HCAHPS domains: pain management, recommendation of hospital, and overall hospital rating. Responses to additional open-ended postdischarge questions were transcribed, coded independently, and analyzed for common themes. From July to December 2014, 90 medical inpatients were enrolled; postdischarge data were collected on 68 (76%) medical inpatients. Participants were 70% females, 43% non-Hispanic black, and 23% Hispanic. No differences between groups were observed on HCAHPS. The qualitative analysis found that massage and music therapy were associated with improved overall hospital experience, pain management, and connectedness to the massage or music therapist. Providing music and massage therapy in an urban safety-net inpatient setting was feasible. There was no quantitative impact on HCAHPS. Qualitative findings suggest benefits related to an improved hospital experience, pain management, and connectedness to the massage or music therapist.

  20. Inpatient Massage Therapy Versus Music Therapy Versus Usual Care: A Mixed-methods Feasibility Randomized Controlled Trial

    Science.gov (United States)

    Cornelio-Flores, Oscar; Lemaster, Chelsey; Hernandez, Maria; Fong, Calvin; Resnick, Kirsten; Wardle, Jon; Hanser, Suzanne; Saper, Robert

    2017-01-01

    Background Little is known about the feasibility of providing massage or music therapy to medical inpatients at urban safety-net hospitals or the impact these treatments may have on patient experience. Objective To determine the feasibility of providing massage and music therapy to medical inpatients and to assess the impact of these interventions on patient experience. Design Single-center 3-arm feasibility randomized controlled trial. Setting Urban academic safety-net hospital. Patients Adult inpatients on the Family Medicine ward. Interventions Massage therapy consisted of a standardized protocol adapted from a previous perioperative study. Music therapy involved a preference assessment, personalized compact disc, music-facilitated coping, singing/playing music, and/or songwriting. Credentialed therapists provided the interventions. Measurements Patient experience was measured with the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) within 7 days of discharge. We compared the proportion of patients in each study arm reporting “top box” scores for the following a priori HCAHPS domains: pain management, recommendation of hospital, and overall hospital rating. Responses to additional open-ended postdischarge questions were transcribed, coded independently, and analyzed for common themes. Results From July to December 2014, 90 medical inpatients were enrolled; postdischarge data were collected on 68 (76%) medical inpatients. Participants were 70% females, 43% non-Hispanic black, and 23% Hispanic. No differences between groups were observed on HCAHPS. The qualitative analysis found that massage and music therapy were associated with improved overall hospital experience, pain management, and connectedness to the massage or music therapist. Conclusions Providing music and massage therapy in an urban safety-net inpatient setting was feasible. There was no quantitative impact on HCAHPS. Qualitative findings suggest benefits related to an

  1. Searching for Elements of Evidence-based Practices in Children’s Usual Care and Examining their Impact

    Science.gov (United States)

    Garland, Ann F.; Accurso, Erin C.; Haine-Schlagel, Rachel; Brookman-Frazee, Lauren; Roesch, Scott; Zhang, Jin Jin

    2014-01-01

    Objective Most of the knowledge generated to bridge the research - practice gap has been derived from experimental studies implementing specific treatment models. Alternatively, this study uses observational methods to generate knowledge about community-based treatment processes and outcomes. Aims are to (1) describe outcome trajectories for children with disruptive behavior problems (DBPs), and (2) test how observed delivery of a benchmark set of practice elements common in evidence-based (EB) treatments may be associated with outcome change, while accounting for potential confounding variables. Method Participants included 190 children ages 4–13 with DBPs and their caregivers, plus 85 psychotherapists, recruited from six clinics. All treatment sessions were video-taped and a random sample of four sessions in the first four months of treatment was reliably coded for intensity on 27 practice elements (benchmark set and others). Three outcomes (child symptom severity, parent discipline, and family functioning) were assessed by parent report at intake, four, and eight months. Data were collected on several potential covariates including child, parent, therapist, and service use characteristics. Multi-level modeling was used to assess relationships between observed practice and outcome slopes, while accounting for covariates. Results Children and families demonstrated improvements in all three outcomes, but few significant associations between treatment processes and outcome change were identified. Families receiving greater intensity on the benchmark practice elements did demonstrate greater improvement in the parental discipline outcome. Conclusion Observed changes in outcomes for families in community care were generally not strongly associated with the type or amount of treatment received. PMID:24555882

  2. Variability in Usual Care Mechanical Ventilation for Pediatric Acute Respiratory Distress Syndrome: Time for a Decision Support Protocol?

    Science.gov (United States)

    Newth, Christopher J L; Sward, Katherine A; Khemani, Robinder G; Page, Kent; Meert, Kathleen L; Carcillo, Joseph A; Shanley, Thomas P; Moler, Frank W; Pollack, Murray M; Dalton, Heidi J; Wessel, David L; Berger, John T; Berg, Robert A; Harrison, Rick E; Holubkov, Richard; Doctor, Allan; Dean, J Michael; Jenkins, Tammara L; Nicholson, Carol E

    2017-11-01

    Although pediatric intensivists philosophically embrace lung protective ventilation for acute lung injury and acute respiratory distress syndrome, we hypothesized that ventilator management varies. We assessed ventilator management by evaluating changes to ventilator settings in response to blood gases, pulse oximetry, or end-tidal CO2. We also assessed the potential impact that a pediatric mechanical ventilation protocol adapted from National Heart Lung and Blood Institute acute respiratory distress syndrome network protocols could have on reducing variability by comparing actual changes in ventilator settings to those recommended by the protocol. Prospective observational study. Eight tertiary care U.S. PICUs, October 2011 to April 2012. One hundred twenty patients (age range 17 d to 18 yr) with acute lung injury/acute respiratory distress syndrome. Two thousand hundred arterial and capillary blood gases, 3,964 oxygen saturation by pulse oximetry, and 2,757 end-tidal CO2 values were associated with 3,983 ventilator settings. Ventilation mode at study onset was pressure control 60%, volume control 19%, pressure-regulated volume control 18%, and high-frequency oscillatory ventilation 3%. Clinicians changed FIO2 by ±5 or ±10% increments every 8 hours. Positive end-expiratory pressure was limited at ~10 cm H2O as oxygenation worsened, lower than would have been recommended by the protocol. In the first 72 hours of mechanical ventilation, maximum tidal volume/kg using predicted versus actual body weight was 10.3 (8.5-12.9) (median [interquartile range]) versus 9.2 mL/kg (7.6-12.0) (p Ventilator management varies substantially in children with acute respiratory distress syndrome. Opportunities exist to minimize variability and potentially injurious ventilator settings by using a pediatric mechanical ventilation protocol offering adequately explicit instructions for given clinical situations. An accepted protocol could also reduce confounding by mechanical

  3. Adequately Addressing Pediatric Obesity: Challenges Faced by Primary Care Providers.

    Science.gov (United States)

    Shreve, Marilou; Scott, Allison; Vowell Johnson, Kelly

    2017-07-01

    To assess the challenges primary care providers encounter when providing counseling for pediatric patients identified as obese. A survey assessed the current challenges and barriers to the screening and treatment of pediatric obesity for providers in northwest Arkansas who provide care to families. The survey consisted of 15 Likert scale questions and 4 open-ended questions. Time, resources, comfort, and cultural issues were reported by providers as the biggest barriers in screening and the treatment of pediatric obesity. All providers reported lack of time as a barrier to providing the care needed for obese children. Cultural barriers of both the provider and client were identified as factors, which negatively affect the care and treatment of obese children. Primary care providers continue to experience challenges when addressing pediatric obesity. In this study, a lack of adequate time to address obesity was identified as the most significant current barrier and may likely be tied to physician resources. Although reimbursement for obesity is increasing, the level of reimbursement does not support the time or the resources needed to treat patients. Many providers reported their patients' cultural view of obesity influenced how they counsel their patients. Increasing providers' knowledge concerning differences in how weight is viewed or valued may assist them in the assessment and care of obese pediatric patients. The challenges identified in previous research continue to limit providers when addressing obesity. Although progress has been made regarding knowledge of guidelines, continuing effort is needed to tackle the remaining challenges. This will allow for earlier identification and intervention, resulting in improved outcomes in pediatric obesity.

  4. Duty to provide care to Ebola patients: the perspectives of Guinean lay people and healthcare providers.

    Science.gov (United States)

    Kpanake, Lonzozou; Tonguino, Tamba Kallas; Sorum, Paul Clay; Mullet, Etienne

    2018-05-21

    To examine the views of Guinean lay people and healthcare providers (HCPs) regarding the acceptability of HCPs' refusal to provide care to Ebola patients. From October to December 2015, lay people (n=252) and HCPs (n=220) in Conakry, Guinea, were presented with 54 sample case scenarios depicting a HCP who refuses to provide care to Ebola patients and were instructed to rate the extent to which this HCP's decision is morally acceptable. The scenarios were composed by systematically varying the levels of four factors: (1) the risk of getting infected, (2) the HCP's working conditions, (3) the HCP's family responsibilities and (4) the HCP's professional status. Five clusters were identified: (1) 18% of the participants expressed the view that HCPs have an unlimited obligation to provide care to Ebola patients; (2) 38% held that HCPs' duty to care is a function of HCPs' working conditions; (3) 9% based their judgments on a combination of risk level, family responsibilities and working conditions; (4) 23% considered that HCPs do not have an obligation to provide care and (5) 12% did not take a position. Only a small minority of Guinean lay people and HCPs consider that HCPs' refusal to provide care to Ebola patients is always unacceptable. The most commonly endorsed position is that HCPs' duty to provide care to Ebola patients is linked to society's reciprocal duty to provide them with the working conditions needed to fulfil their professional duty. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  5. A randomized controlled trial on early physiotherapy intervention versus usual care in acute care unit for elderly: potential benefits in light of dietary intakes.

    NARCIS (Netherlands)

    Blanc-Bisson, C.; Dechamps, A.A.; Gouspillou, G.; Dehail, P.; Bourdel-Marchasson, I.

    2008-01-01

    OBJECTIVE: To evaluate effects of early intensive physiotherapy during acute illness on post hospitalization activity daily living autonomy (ADL). DESIGN: Prospective randomized controlled trial of intensive physiotherapy rehabilitation on day 1 to 2 after admission until clinical stability or usual

  6. Surrogate pregnancy: a guide for Canadian prenatal health care providers

    Science.gov (United States)

    Reilly, Dan R.

    2007-01-01

    Providing health care for a woman with a surrogate pregnancy involves unique challenges. Although the ethical debate surrounding surrogacy continues, Canada has banned commercial, but not altruistic, surrogacy. In the event of a custody dispute between a surrogate mother and the individual(s) intending to parent the child, it is unclear how Canadian courts would rule. The prenatal health care provider must take extra care to protect the autonomy and privacy rights of the surrogate. There is limited evidence about the medical and psychological risks ofsurrogacy. Whether theoretical concerns about these risks are clinically relevant remains unknown. In the face of these uncertainties, the prenatal health care provider should have a low threshold for seeking obstetrical, social work, ethical and legal support. PMID:17296962

  7. Surrogate pregnancy: a guide for Canadian prenatal health care providers.

    Science.gov (United States)

    Reilly, Dan R

    2007-02-13

    Providing health care for a woman with a surrogate pregnancy involves unique challenges. Although the ethical debate surrounding surrogacy continues, Canada has banned commercial, but not altruistic, surrogacy. In the event of a custody dispute between a surrogate mother and the individual(s) intending to parent the child, it is unclear how Canadian courts would rule. The prenatal health care provider must take extra care to protect the autonomy and privacy rights of the surrogate. There is limited evidence about the medical and psychological risks of surrogacy. Whether theoretical concerns about these risks are clinically relevant remains unknown. In the face of these uncertainties, the prenatal health care provider should have a low threshold for seeking obstetrical, social work, ethical and legal support.

  8. Complexities of Providing Dental Hygiene Services in Community Care Settings.

    Science.gov (United States)

    Zarkowski, Pamela; Aksu, Mert N

    2016-06-01

    Direct access care provided by dental hygienists can reduce oral health disparities for the underserved, yet legal, regulatory, and ethical considerations create complexities and limits. Individual state dental practice acts regulate the scope of practice and level of supervision required when dental hygienists deliver care. Yet, inconsistent state practice act regulations contribute to ethical and legal limitations and dilemmas for practitioners. The dental hygienist is positioned to assume an increasingly larger role in the management of oral health disparities. However, there are several legal and ethical considerations that impact both dental hygienists and dentists providing care in complex community settings. This article informs dental hygienists and other related constituencies about conundrums that are encountered when providing care 'beyond the operatory.' An evidence-based view of ways in which dental hygienists are reducing oral health disparities illustrates the complex issues involved in providing such care. Potential scenarios that can occur during care provision in underserved settings provide the basis for a discussion of legal and other associated issues impacting dental hygiene practice. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Providers' Perceptions of Challenges in Obstetrical Care for Somali Women

    Directory of Open Access Journals (Sweden)

    Jalana N. Lazar

    2013-01-01

    Full Text Available Background. This pilot study explored health care providers’ perceptions of barriers to providing health care services to Somali refugee women. The specific aim was to obtain information about providers’ experiences, training, practices and attitudes surrounding the prenatal care, delivery, and management of women with Female Genital Cutting (FGC. Methods. Individual semi-structured interviews were conducted with 14 obstetricians/gynecologists and nurse midwives in Columbus, Ohio. Results. While providers did not perceive FGC as a significant barrier in itself, they noted considerable challenges in communicating with their Somali patients and the lack of formal training or protocols guiding the management of circumcised women. Providers expressed frustration with what they perceived as Somali patients' resistance to obstetrical interventions and disappointment with a perception of mistrust from patients and their families. Conclusion. Improving the clinical encounter for both patients and providers entails establishing effective dialogue, enhancing clinical and cultural training of providers, improving health literacy, and developing trust through community engagement.

  10. Effective factors in providing holistic care: A qualitative study

    Directory of Open Access Journals (Sweden)

    Vahid Zamanzadeh

    2015-01-01

    Full Text Available Background: Holistic care is a comprehensive model of caring. Previous studies have shown that most nurses do not apply this method. Examining the effective factors in nurses′ provision of holistic care can help with enhancing it. Studying these factors from the point of view of nurses will generate real and meaningful concepts and can help to extend this method of caring. Materials and Methods: A qualitative study was used to identify effective factors in holistic care provision. Data gathered by interviewing 14 nurses from university hospitals in Iran were analyzed with a conventional qualitative content analysis method and by using MAXQDA (professional software for qualitative and mixed methods data analysis software. Results: Analysis of data revealed three main themes as effective factors in providing holistic care: The structure of educational system, professional environment, and personality traits. Conclusion: Establishing appropriate educational, management systems, and promoting religiousness and encouragement will induce nurses to provide holistic care and ultimately improve the quality of their caring.

  11. Otolaryngology Needs in a Free Clinic Providing Indigent Care.

    Science.gov (United States)

    Hu, Amanda; Sibert, Thomas; Zhao, Wei; Zarro, Vincent

    2016-06-01

    To determine the otolaryngology needs in a free clinic providing care to medically indigent patients, as perceived by the patients and health care providers. Cross-sectional survey. A survey was administered to patients and health care providers of a free clinic from September 2014 through January 2015 in an urban, inner-city location. One hundred and thirty-seven patients (35.8% male, age 50.8 ± 13.0 years) completed the survey. Mean household income was $29,838 ± $10,425; 32.1% spoke English; 54.7% were employed; 10.2% had health insurance; and 37.2% had seen a primary care provider outside of the free clinic. The top three otolaryngology symptoms among patients were sleep apnea/snoring (39.4%), heartburn/reflux (30.7%), and dizziness (29.9%). Eleven health care providers (45% male, age 50.5 ± 15.3 years, 63.6% physician, 36% nurse) completed the survey. Providers perceived the following otolaryngology complaints as the most prevalent, in descending order: cough, nasal congestion, reflux/heartburn, sore throat, and ear infection/otalgia. Providers felt that sleep apnea and hearing loss were the less common otolaryngology complaints, whereas surveyed patients indicated these symptoms with high frequency. The most requested diagnostic tool among patients and providers was chest X-rays. There are unmet otolaryngology needs in a free clinic. Medically indigent patients have significant barriers to accessing health care. Patient and provider perceptions of top otolaryngology complaints differed, but both identified access to chest X-rays as a major unmet need. Knowledge of patient perceptions may help providers elicit the breadth of otolaryngology complaints. 4. Laryngoscope, 126:1321-1326, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  12. Clinical- and cost-effectiveness of the STAR care pathway compared to usual care for patients with chronic pain after total knee replacement: study protocol for a UK randomised controlled trial.

    Science.gov (United States)

    Wylde, Vikki; Bertram, Wendy; Beswick, Andrew D; Blom, Ashley W; Bruce, Julie; Burston, Amanda; Dennis, Jane; Garfield, Kirsty; Howells, Nicholas; Lane, Athene; McCabe, Candy; Moore, Andrew J; Noble, Sian; Peters, Tim J; Price, Andrew; Sanderson, Emily; Toms, Andrew D; Walsh, David A; White, Simon; Gooberman-Hill, Rachael

    2018-02-21

    Approximately 20% of patients experience chronic pain after total knee replacement. There is little evidence for effective interventions for the management of this pain, and current healthcare provision is patchy and inconsistent. Given the complexity of this condition, multimodal and individualised interventions matched to pain characteristics are needed. We have undertaken a comprehensive programme of work to develop a care pathway for patients with chronic pain after total knee replacement. This protocol describes the design of a randomised controlled trial to evaluate the clinical- and cost-effectiveness of a complex intervention care pathway compared with usual care. This is a pragmatic two-armed, open, multi-centred randomised controlled trial conducted within secondary care in the UK. Patients will be screened at 2 months after total knee replacement and 381 patients with chronic pain at 3 months postoperatively will be recruited. Recruitment processes will be optimised through qualitative research during a 6-month internal pilot phase. Patients are randomised using a 2:1 intervention:control allocation ratio. All participants receive usual care as provided by their hospital. The intervention comprises an assessment clinic appointment at 3 months postoperatively with an Extended Scope Practitioner and up to six telephone follow-up calls over 12 months. In the assessment clinic, a standardised protocol is followed to identify potential underlying causes for the chronic pain and enable appropriate onward referrals to existing services for targeted and individualised treatment. Outcomes are assessed by questionnaires at 6 and 12 months after randomisation. The co-primary outcomes are pain severity and pain interference assessed using the Brief Pain Inventory at 12 months after randomisation. Secondary outcomes relate to resource use, function, neuropathic pain, mental well-being, use of pain medications, satisfaction with pain relief, pain frequency, capability

  13. Patient, Provider, and Combined Interventions for Managing Osteoarthritis in Primary Care: A Cluster Randomized Trial.

    Science.gov (United States)

    Allen, Kelli D; Oddone, Eugene Z; Coffman, Cynthia J; Jeffreys, Amy S; Bosworth, Hayden B; Chatterjee, Ranee; McDuffie, Jennifer; Strauss, Jennifer L; Yancy, William S; Datta, Santanu K; Corsino, Leonor; Dolor, Rowena J

    2017-03-21

    A single-site study showed that a combined patient and provider intervention improved outcomes for patients with knee osteoarthritis, but it did not assess separate effects of the interventions. To examine whether patient-based, provider-based, and patient-provider interventions improve osteoarthritis outcomes. Cluster randomized trial with assignment to patient, provider, and patient-provider interventions or usual care. (ClinicalTrials.gov: NCT01435109). 10 Duke University Health System community-based primary care clinics. 537 outpatients with symptomatic hip or knee osteoarthritis. The telephone-based patient intervention focused on weight management, physical activity, and cognitive behavioral pain management. The provider intervention involved electronic delivery of patient-specific osteoarthritis treatment recommendations to providers. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score at 12 months. Secondary outcomes were objective physical function (Short Physical Performance Battery) and depressive symptoms (Patient Health Questionnaire). Linear mixed models assessed the difference in improvement among groups. No difference was observed in WOMAC score changes from baseline to 12 months in the patient (-1.5 [95% CI, -5.1 to 2.0]; P = 0.40), provider (2.5 [CI, -0.9 to 5.9]; P = 0.152), or patient-provider (-0.7 [CI, -4.2 to 2.8]; P = 0.69) intervention groups compared with usual care. All groups had improvements in WOMAC scores at 12 months (range, -3.7 to -7.7). In addition, no differences were seen in objective physical function or depressive symptoms at 12 months in any of the intervention groups compared with usual care. The study involved 1 health care network. Data on provider referrals were not collected. Contrary to a previous study of a combined patient and provider intervention for osteoarthritis in a Department of Veterans Affairs medical center, this study found no statistically

  14. Health Care Provider Accommodations for Patients with Communication Disorders

    Science.gov (United States)

    Burns, Michael I.; Baylor, Carolyn; Dudgeon, Brian J.; Starks, Helene; Yorkston, Kathryn

    2017-01-01

    Health care providers can experience increased diffculty communicating with adult patients during medical interactions when the patients have communication disorders. Meeting the communication needs of these patients can also create unique challenges for providers. The authors explore Communication Accommodation Theory (H. Giles, 1979) as a guide…

  15. Impact of Health Care Provider's Training on Patients ...

    African Journals Online (AJOL)

    Material and Methods: A situation analysis was done before training to assess existing practice of providers' communication skills and patient's satisfaction. All care providers in labour ward were trained and their practice was assessed before and after training. A ten percent sample of patients delivered in hospital before ...

  16. Providing Medical Care in Yekaterynoslav during World War I

    Directory of Open Access Journals (Sweden)

    V.V. Haponov

    2015-04-01

    Full Text Available Providing medical care to the ill and wounded persons during World War I in Yekaterynoslav is described. The history of the creation of field hospitals, military hospitals, Red Cross hospitals and church-monument to the fallen heroes is presented. The selfless work of military medical personnel is shown. Biographical information about a doctor, public figure Yefim Pavlovskyi is provided.

  17. Evaluation of patients ' satisfaction with quality of care provided at ...

    African Journals Online (AJOL)

    Background: The umpteenth threats to change of healthcare provider by dissatisfied patients on formal sector health insurance are well known and can be a proxy indicator for the need for quality improvement in service delivery. Objective: This study was aimed at evaluating patientsf satisfaction with quality of care provided ...

  18. Provider and systems factors in diabetes quality of care.

    Science.gov (United States)

    Ghaznavi, Kimia; Malik, Shaista

    2012-02-01

    A gap exists in knowledge and the observed frequency with which patients with diabetes actually receive treatment for optimal cardiovascular risk reduction. Many interventions to improve quality of care have been targeted at the health systems level and provider organizations. Changes in several domains of care and investment in quality by organizational leaders are needed to make long-lasting improvements. In the studies reviewed, the most effective strategies often have multiple components, whereas the use of one single strategy, such as reminders only or an educational intervention, is less effective. More studies are needed to examine the effect of several care management strategies simultaneously, such as use of clinical information systems, provider financial incentives, and organizational model on processes of care and outcomes.

  19. Cultural competency: providing quality care to diverse populations.

    Science.gov (United States)

    Betancourt, Joseph R

    2006-12-01

    The goal of this paper is to define cultural competence and present a practical framework to address crosscultural challenges that emerge in the clinical encounter, with a particular focus on the issue of nonadherence. English-language literature, both primary and reports from various agencies, and the author's personal experiences in clinical practice. Relevant literature on patient-centered care and cultural competence. There is a growing literature that delineates the impact of sociocultural factors, race, ethnicity, and limited-English proficiency on health and clinical care. The field of cultural competence focuses on addressing these issues. Health care providers need a practical set of tools and skills that will enable them to provide quality care to patients during a brief encounter, whatever differences in background that may exist. Cultural competence has evolved from the gathering of information and making of assumptions about patients on the basis of their sociocultural background to the development of skills to implement the principles of patient-centered care. This patient-based approach to cross-cultural care consists of first, assessing core cross-cultural issues; second, exploring the meaning of the illness to the patient; third, determining the social context in which the patient lives; and fourth, engaging in negotiation with the patient to encourage adherence. Addressing adherence is a particularly challenging issue, the determinants of which are multifactorial, and the ESFT (explanatory/social/fears/treatment) model--derived from the patient-based approach--is a tool that identifies barriers to adherence and provides strategies to address them. It obviously is impossible to learn everything about every culture and that should not be expected. Instead, we should learn about the communities we care for. More important, we should have a framework that allows us to provide appropriate care for any patient--one that deals with issues of adherence

  20. Hiring appropriate providers for different populations: acute care nurse practitioners.

    Science.gov (United States)

    Haut, Cathy; Madden, Maureen

    2015-06-01

    Acute care nurse practitioners, prepared as providers for a variety of populations of patients, continue to make substantial contributions to health care. Evidence indicates shorter stays, higher satisfaction among patients, increased work efficiency, and higher quality outcomes when acute care nurse practitioners are part of unit- or service-based provider teams. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education outlines detailed guidelines for matching nurse practitioners' education with certification and practice by using a population-focused algorithm. Despite national support for the model, nurse practitioners and employers continue to struggle with finding the right fit. Nurse practitioners often use their interest and previous nursing experience to apply for an available position, and hospitals may not understand preparation or regulations related to matching the appropriate provider to the work environment. Evidence and regulatory guidelines indicate appropriate providers for population-focused positions. This article presents history and recommendations for hiring acute care nurse practitioners as providers for different populations of patients. ©2015 American Association of Critical-Care Nurses.

  1. Achieving health care cost containment through provider payment reform that engages patients and providers.

    Science.gov (United States)

    Ginsburg, Paul B

    2013-05-01

    The best opportunity to pursue cost containment in the next five to ten years is through reforming provider payment to gradually diminish the role of fee-for-service reimbursement. Public and private payers have launched many promising payment reform pilots aimed at blending fee-for-service with payment approaches based on broader units of care, such as an episode or patients' total needs over a period of time, a crucial first step. But meaningful cost containment from payment reform will not be achieved until Medicare and Medicaid establish stronger incentives for providers to contract in this way, with discouragement of nonparticipation increasing over time. In addition, the models need to evolve to engage beneficiaries, perhaps through incentives for patients to enroll in an accountable care organization and to seek care within that organization's network of providers.

  2. Encounter Decision Aid vs. Clinical Decision Support or Usual Care to Support Patient-Centered Treatment Decisions in Osteoporosis: The Osteoporosis Choice Randomized Trial II.

    Directory of Open Access Journals (Sweden)

    Annie LeBlanc

    Full Text Available Osteoporosis Choice, an encounter decision aid, can engage patients and clinicians in shared decision making about osteoporosis treatment. Its effectiveness compared to the routine provision to clinicians of the patient's estimated risk of fracture using the FRAX calculator is unknown.Patient-level, randomized, three-arm trial enrolling women over 50 with osteopenia or osteoporosis eligible for treatment with bisphosphonates, where the use of Osteoporosis Choice was compared to FRAX only and to usual care to determine impact on patient knowledge, decisional conflict, involvement in the decision-making process, decision to start and adherence to bisphosphonates.We enrolled 79 women in the three arms. Because FRAX estimation alone and usual care produced similar results, we grouped them for analysis. Compared to these, use of Osteoporosis Choice increased patient knowledge (median score 6 vs. 4, p = .01, improved understanding of fracture risk and risk reduction with bisphosphonates (p = .01 and p<.0001, respectively, had no effect on decision conflict, and increased patient engagement in the decision making process (OPTION scores 57% vs. 43%, p = .001. Encounters with the decision aid were 0.8 minutes longer (range: 33 minutes shorter to 3.0 minutes longer. There were twice as many patients receiving and filling prescriptions in the decision aid arm (83% vs. 40%, p = .07; medication adherence at 6 months was no different across arms.Supporting both patients and clinicians during the clinical encounter with the Osteoporosis Choice decision aid efficiently improves treatment decision making when compared to usual care with or without clinical decision support with FRAX results.clinical trials.gov NCT00949611.

  3. Effect of nurse home visits vs. usual care on reducing intimate partner violence in young high-risk pregnant women: a randomized controlled trial.

    Science.gov (United States)

    Mejdoubi, Jamila; van den Heijkant, Silvia C C M; van Leerdam, Frank J M; Heymans, Martijn W; Hirasing, Remy A; Crijnen, Alfons A M

    2013-01-01

    Expectant mothers and mothers of young children are especially vulnerable to intimate partner violence (IPV). The nurse-family partnership (NFP) is a home visitation program in the United States effective for the prevention of adverse child health outcomes. Evidence regarding the effect of nurse home visiting on IPV is inconsistent. This study aims to study the effect of VoorZorg, the Dutch NFP, on IPV. A random sample of 460 eligible disadvantaged women births, was randomized. Women in the control group (C; n=223) received usual care; women in the intervention group (I; n=237) received usual care plus nurse home visits periodically during pregnancy and until the child's second birthday. At 32 weeks of pregnancy, women in the intervention group self-reported significantly less IPV victimization than women in the control group in: level 2 psychological aggression (C: 56% vs. I: 39%), physical assault level 1 (C: 58% vs. I: 40%) and level 2 (C: 31% vs. I: 20%), and level 1 sexual coercion (C: 16% vs. I: 8%). Furthermore, women in the intervention group reported significantly less IPV perpetration in: level 2 psychological aggression (C: 60% vs. I: 46%), level 1 physical assault (C: 65% vs. I: 52%), and level 1 injury (C: 27% vs. I: 17%). At 24 months after birth, IPV victimization was significantly lower in the intervention group for level 1 physical assault (C: 44% vs. I: 26%), and IPV perpetration was significantly lower for level 1 sexual assault (C: 18% vs. I: 3%). Multilevel analyses showed a significant improvement in IPV victimization and perpetration among women in the intervention group at 24 months after birth. VoorZorg, compared with the usual care, is effective in reducing IPV during pregnancy and in the two years after birth among young high-risk women. Dutch Trial Register NTR854 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=854.

  4. Primary Care Providers' experiences with Pharmaceutical Care-based Medication Therapy Management Services

    Directory of Open Access Journals (Sweden)

    Heather L. Maracle

    2012-01-01

    Full Text Available This study explored primary care providers' (PCPs experiences with the practice of pharmaceutical care-based medication therapy management (MTM. Qualitative, semi-structured interviews were conducted with six PCPs who have experiences working with MTM pharmacists for at least three years. The first author conducted the interviews that were audio-taped, transcribed, and coded independently. The codes were then harmonized via discussion and consensus with the other authors. Data were analyzed for themes using the hermeneutic-phenomenological method as proposed by Max van Manen. Three men and three women were interviewed. On average, the interviewees have worked with MTM pharmacists for seven years. The six (6 themes uncovered from the interviews included: (1 "MTM is just part of our team approach to the practice of medicine": MTM as an integral part of PCPs' practices; (2 "Frankly it's education for the patient but it's also education for me": MTM services as a source of education; (3 "It's not exactly just the pharmacist that passes out the medicines at the pharmacy": The MTM practitioner is different from the dispensing pharmacist; (4 "So, less reactive, cleaning up the mess, and more proactive and catching things before they become so involved": MTM services as preventative health care efforts; (5"I think that time is the big thing": MTM pharmacists spend more time with patients; (6 "There's an access piece, there's an availability piece, there's a finance piece": MTM services are underutilized at the clinics. In conclusion, PCPs value having MTM pharmacists as part of their team in ambulatory clinics. MTM pharmacists are considered an important source of education to patients as well as to providers as they are seen as having a unique body of knowledge äóñmedication expertise. All PCPs highly treasure the time and education provided by the MTM pharmacists, their ability to manage and adjust patients' medications, and their capability to

  5. Male nurses' experiences of providing intimate care for women clients.

    Science.gov (United States)

    Inoue, Madoka; Chapman, Rose; Wynaden, Dianne

    2006-09-01

    This paper reports a study of male nurses' experiences of providing intimate care for women clients. The number of men entering the nursing profession has increased worldwide. As a consequence of the move to a more gender-balanced profession, debate has ensued over how intimate care should be performed when this requires male nurses to be physically close to women clients. As there was little previous work on this topic, we wished to provide nurses, clients and other healthcare professionals with a better understanding of male nurses' experiences of working with women clients and within a healthcare system where they often feel excluded. Semi-structured, open-ended interviews were conducted with male nurses working in various clinical settings in Western Australia. Latent content analysis was used to analyse the interviews, which were carried out between June and July 2004. Three themes were identified: the definition of intimate care, the emotional experience associated with providing intimate care and strategies used to assist in the delivery of intimate care for women clients. Providing intimate care for women clients was a challenging experience for male nurses. Participants described how it required them to invade these clients' personal space. Consequently, they often experienced various negative feelings and used several strategies to assist them during care delivery. Nurse educators should assist male nurses to be better prepared to interact with women clients in various settings. Furthermore, workplace environments need to provide additional support and guidance for male nurses to enable them to develop effective coping strategies to manage challenging situations.

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

    Science.gov (United States)

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

    2018-01-01

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

  7. Efficacy of a minimal home-based psychoeducative intervention versus usual care for managing anxiety and dyspnoea in patients with severe chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Bove, Dorthe Gaby; Overgaard, Dorthe; Lomborg, Kirsten

    2015-01-01

    investigates the efficacy of a minimal home-based psychoeducative intervention versus usual care for patients with severe chronic obstructive pulmonary disease. METHODS AND ANALYSIS: The trial is a randomised controlled trial with a 4-week and 3-month follow-up. 66 patients with severe chronic obstructive...... pulmonary disease and associated anxiety will be randomised 1:1 to either an intervention or control group. The intervention consists of a single psychoeducative session in the patient's home in combination with a telephone booster session. The intervention is based on a manual, with a theoretical...

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

    Directory of Open Access Journals (Sweden)

    Slooff Cees J

    2007-06-01

    Full Text Available Abstract Background In primary care, GPs usually provide care for patients with chronic diseases according to professional guidelines. However, such guidelines are not available in the Netherlands for patients with recurring psychoses. It seems that the specific difficulties that GPs experience in providing care for these patients hinder the development and implementation of such guidelines. This study aims to explore the chances and problems GPs meet when providing care for patients susceptible for recurring psychoses, including schizophrenia and related disorders, bipolar disorder, and psychotic depression. Methods A qualitative study of focus group discussions with practising GPs in both town and rural areas. Transcripts from three focus groups with 19 GPs were analysed with the computer program 'Kwalitan'. Theoretical saturation was achieved after these three groups. Results Analysis showed that eight categories of factors influenced the GPs' care for psychotic patients: patient presentation (acute vs. chronic phase, emotional impact, expertise, professional attitude, patient related factors, patient's family, practice organization, and collaboration with psychiatric specialists. Conclusion Current primary care for psychotic patients depends very much on personal characteristics of the GP and the quality of local collaboration with the Mental Health Service. A quantitative study among GPs using a questionnaire based on the eight categories mentioned above would determine the extent of the problems and limitations experienced with this type of care. From the results of this quantitative study, new realistic guidelines could be developed to improve the quality of care for psychotic patients.

  9. Requests from professional care providers for consultation with palliative care consultation teams.

    NARCIS (Netherlands)

    Groot, M.F. de; Vernooy-Dassen, M.J.F.J.; Courtens, A.M.; Kuin, A.; Linden, B.A. van der; Zuylen, L. van; Crul, B.J.P.; Grol, R.P.T.M.

    2005-01-01

    GOALS OF WORK: Professional care providers need a substantial basis of competence and expertise to provide appropriate palliative care. Little is known about the problems professionals experience in their palliative care provision in daily practice or about the nature of the advice and support they

  10. Exploring the role of farm animals in providing care at care farms

    NARCIS (Netherlands)

    Hassink, Jan; Bruin, de Simone R.; Berget, Bente; Elings, Marjolein

    2017-01-01

    We explore the role of farm animals in providing care to different types of participants at care farms (e.g., youngsters with behavioural problems, people with severe mental problems and people with dementia). Care farms provide alternative and promising settings where people can interact with

  11. Exploring the Role of Farm Animals in Providing Care at Care Farms.

    NARCIS (Netherlands)

    Hassink, Jan; De Bruin, Simone R; Berget, Bente; Elings, Marjolein

    2017-01-01

    We explore the role of farm animals in providing care to different types of participants at care farms (e.g., youngsters with behavioural problems, people with severe mental problems and people with dementia). Care farms provide alternative and promising settings where people can interact with

  12. Iranian women and care providers' perceptions of equitable prenatal care: A qualitative study.

    Science.gov (United States)

    Gheibizadeh, Mahin; Abedi, Heidar Ali; Mohammadi, Easa; Abedi, Parvin

    2016-06-01

    Equity as a basic human right builds the foundation of all areas of primary healthcare, especially prenatal care. However, it is unclear how pregnant women and their care providers perceive the equitable prenatal care. This study aimed to explore Iranian women's and care providers' perceptions of equitable prenatal care. In this study, a qualitative approach was used. Individual in-depth unstructured interviews were conducted with a purposeful sample of pregnant women and their care providers. Data were analyzed using inductive content analysis method. A total of 10 pregnant women and 10 prenatal care providers recruited from six urban health centers across Ahvaz, a south western city in Iran, were participated in the study. The study was approved by the Ethics Committee affiliated to Ahvaz Jundishapur University of Medical Sciences. The ethical principles of voluntary participation, confidentiality, and anonymity were considered. Analysis of participants' interviews resulted in seven themes: guideline-based care, time-saving care, nondiscriminatory care, privacy-respecting care, affordable comprehensive care, effective client-provider relationships, and caregivers' competency. The findings explain the broader and less discussed dimensions of equitable care that are valuable information for the realization of equity in care. Understanding and focusing on these dimensions will help health policy-makers in designing more equitable healthcare services for pregnant women. © The Author(s) 2015.

  13. Effectiveness of additional self-care acupressure for women with menstrual pain compared to usual care alone: using stakeholder engagement to design a pragmatic randomized trial and study protocol.

    Science.gov (United States)

    Blödt, Susanne; Schützler, Lena; Huang, Wenjing; Pach, Daniel; Brinkhaus, Benno; Hummelsberger, Josef; Kirschbaum, Barbara; Kuhlmann, Kirsten; Lao, Lixing; Liang, Fanrong; Mietzner, Anna; Mittring, Nadine; Müller, Sabine; Paul, Anna; Pimpao-Niederle, Carolina; Roll, Stephanie; Wu, Huangan; Zhu, Jiang; Witt, Claudia M

    2013-04-11

    Self-care acupressure might be successful in treating menstrual pain, which is common among young women. There is a need for comparative effectiveness research with stakeholder engagement in all phases seeking to address the needs of decision-makers. Our aim was to design a study on the effectiveness of additional self-care acupressure for menstrual pain comparing usual care alone using different methods of stakeholder engagement. The study was designed using multiple mixed methods for stakeholder engagement. Based on the results of a survey and focus group discussion, a stakeholder advisory group developed the study design. Stakeholder engagement resulted in a two-arm pragmatic randomized trial. Two hundred and twenty women aged 18 to 25 years with menstrual pain will be included in the study. Outcome measurement will be done using electronic questionnaires provided by a study specific mobile application (App). Primary outcome will be the mean pain intensity at the days of pain during the third menstruation after therapy start. Stakeholder engagement helped to develop a study design that better serves the needs of decision makers, including an App as a modern tool for both intervention and data collection in a young target group. Clinicaltrials.gov identifier http://NCT01582724.

  14. Mud-Bath Therapy in Addition to Usual Care in Bilateral Knee Osteoarthritis: An Economic Evaluation Alongside a Randomized Controlled Trial.

    Science.gov (United States)

    Ciani, Oriana; Pascarelli, Nicola Antonio; Giannitti, Chiara; Galeazzi, Mauro; Meregaglia, Michela; Fattore, Giovanni; Fioravanti, Antonella

    2017-07-01

    To perform a cost-effectiveness analysis of mud-bath therapy (MBT) in addition to usual treatment compared to usual treatment alone in patients with bilateral knee osteoarthritis (OA). An economic evaluation alongside a randomized controlled trial was conducted. Patients were randomly assigned to receive either a 2-week cycle of MBT in addition to their usual treatment or to continue routine care alone. The EuroQol 5-domain questionnaire was administered at baseline, 2 weeks, and at 3, 6, 9, and 12 months. Direct health care resource consumption data up until 12 months were derived from a daily diary given to patients and returned at prescheduled followup visits. A total of 103 patients were included (n = 53 for MBT patients; n = 50 for controls). Overall, patients in the MBT group accrued mean ± SD 0.835 ± 0.10 quality-adjusted life years (QALYs) compared to 0.753 ± 0.11 in the control group (P < 0.001). Average direct costs per patient (€303 versus €975; P < 0.001) were higher in the control group, primarily because of hospitalization for total knee replacement and use of intraarticular hyaluronic acid. Bootstrapping replications of costs and QALY sample distributions consistently indicated that the MBT therapy combined with standard therapy represents a dominant strategy as compared with standard therapy alone. The probability of MBT being cost-effective at standard cost-effectiveness thresholds (e.g., €20,000/QALY) is 100%. The results of this cost-effectiveness analysis support the use of MBT as midterm complementary therapy in the management of knee OA. © 2016, American College of Rheumatology.

  15. Use of a pharmacy technician to facilitate postfracture care provided by clinical pharmacy specialists.

    Science.gov (United States)

    Irwin, Adriane N; Heilmann, Rachel M F; Gerrity, Theresa M; Kroner, Beverly A; Olson, Kari L

    2014-12-01

    The ability of a pharmacy technician to support the patient screening and documentation-related functions of a pharmacist-driven osteoporosis management service was evaluated. A two-phase prospective study was conducted within a large integrated health system to assess a pharmacy technician's performance in supporting a multisite team of clinical pharmacy specialists providing postfracture care. In phase I of the study, a specially trained pharmacy technician provided support to pharmacists at five participating medical offices, helping to identify patients requiring pharmacist intervention and, when applicable, collecting patient-specific clinical information from the electronic health record. In phase II of the study, the amount of pharmacist time saved through the use of technician support versus usual care was evaluated. The records of 127 patient cases were reviewed by the pharmacy technician during phase I of the study, and a pharmacist agreed with the technician's determination of the need for intervention in the majority of instances (92.9%). An additional 91 patient cases were reviewed by the technician in phase II of the research. With technician support, pharmacists spent less time reviewing cases subsequently determined as not requiring intervention (mean ± S.D., 5.0 ± 3.8 minutes per case compared with 5.2 ± 4.5 minutes under the usual care model; p = 0.78). In cases requiring intervention, technician support was associated with a reduction in the average pharmacist time spent on care plan development (13.5 ± 7.1 minutes versus 18.2 ± 16.6 minutes with usual care, p = 0.34). The study results suggest that a pharmacy technician can accurately determine if a patient is a candidate for pharmacist intervention and collect clinical information to facilitate care plan development. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  16. Primary Health Care Providers' Knowledge Gaps on Parkinson's Disease

    Science.gov (United States)

    Thompson, Megan R.; Stone, Ramona F.; Ochs, V. Dan; Litvan, Irene

    2013-01-01

    In order to determine primary health care providers' (PCPs) knowledge gaps on Parkinson's disease, data were collected before and after a one-hour continuing medical education (CME) lecture on early Parkinson's disease recognition and treatment from a sample of 104 PCPs participating at an annual meeting. The main outcome measure was the…

  17. Can health care providers recognize a fibromyalgia personality?

    NARCIS (Netherlands)

    Da Silva, J.A.P.; Jacobs, J.W.G.; Branco, J.; Canaipa, R.; Gaspar, M.F.; Griep, E.N.; van Helmond, T.; Oliveira, P.J.; Zijlstra, T.R.; Geenen, R.

    2017-01-01

    OBJECTIVES: To determine if experienced health care providers (HCPs) can recognise patients with fibromyalgia (FM) based on a limited set of personality items, exploring the existence of a FM personality. METHODS: From the 240-item NEO-PI-R personality questionnaire, 8 HCPs from two different

  18. Knowledge, attitudes and opinions of health care providers in Minna ...

    African Journals Online (AJOL)

    Conclusion: The study revealed grossly inadequate knowledge on the operational principles of the scheme, but a positive attitudinal predisposition among health care providers studied. This calls for a conscious publicity drive and intensive educational campaigns. Keywords: knowledge, attitudes, opinions, healthcare ...

  19. Growing Healthy Bodies: Nutrition Education for Day Care Providers.

    Science.gov (United States)

    Viebrock, Margaret A.; Berry, Holly

    This booklet discusses the important role that day care providers can play in ensuring that children eat healthy snacks and meals and learn good eating habits. Section one of the booklet examines snack foods, discusses the difference between nutritious and less-nutritious snacks, and recommends snack foods appropriate for different age groups.…

  20. Theory in Practice: Helping Providers Address Depression in Diabetes Care

    Science.gov (United States)

    Osborn, Chandra Y.; Kozak, Cindy; Wagner, Julie

    2010-01-01

    Introduction: A continuing education (CE) program based on the theory of planned behavior was designed to understand and improve health care providers' practice patterns in screening, assessing, and treating and/or referring patients with diabetes for depression treatment. Methods: Participants completed assessments of attitudes, confidence,…

  1. Agents for change: nonphysician medical providers and health care quality.

    Science.gov (United States)

    Boucher, Nathan A; Mcmillen, Marvin A; Gould, James S

    2015-01-01

    Quality medical care is a clinical and public health imperative, but defining quality and achieving improved, measureable outcomes are extremely complex challenges. Adherence to best practice invariably improves outcomes. Nonphysician medical providers (NPMPs), such as physician assistants and advanced practice nurses (eg, nurse practitioners, advanced practice registered nurses, certified registered nurse anesthetists, and certified nurse midwives), may be the first caregivers to encounter the patient and can act as agents for change for an organization's quality-improvement mandate. NPMPs are well positioned to both initiate and ensure optimal adherence to best practices and care processes from the moment of initial contact because they have robust clinical training and are integral to trainee/staff education and the timely delivery of care. The health care quality aspects that the practicing NPMP can affect are objective, appreciative, and perceptive. As bedside practitioners and participants in the administrative and team process, NPMPs can fine-tune care delivery, avoiding the problem areas defined by the Institute of Medicine: misuse, overuse, and underuse of care. This commentary explores how NPMPs can affect quality by 1) supporting best practices through the promotion of guidelines and protocols, and 2) playing active, if not leadership, roles in patient engagement and organizational quality-improvement efforts.

  2. Early motion and directed exercise (EMADE) versus usual care post ankle fracture fixation: study protocol for a pragmatic randomised controlled trial.

    Science.gov (United States)

    Matthews, Paul A; Scammell, Brigitte E; Ali, Arfan; Coughlin, Timothy; Nightingale, Jessica; Khan, Tanvir; Ollivere, Ben J

    2018-05-31

    Following surgical fixation of ankle fractures, the traditional management has included immobilisation for 6 weeks in a below-knee cast. However, this can lead to disuse atrophy of the affected leg and joint stiffness. While early rehabilitation from 2 weeks post surgery is viewed as safe, controversy remains regarding its benefits. We will compare the effectiveness of early motion and directed exercise (EMADE) ankle rehabilitation, against usual care, i.e. 6 weeks' immobilisation in a below-knee cast. We have designed a pragmatic randomised controlled trial (p-RCT) to compare the EMADE intervention against usual care. We will recruit 144 independently living adult participants, absent of tissue-healing comorbidities, who have undergone surgical stabilisation of isolated Weber B ankle fractures. The EMADE intervention consists of a non-weight-bearing progressive home exercise programme, complemented with manual therapy and education. Usual care consists of immobilisation in a non-weight-bearing below-knee cast. The intervention period is between week 2 and week 6 post surgery. The primary outcome is the Olerud and Molander Ankle Score (OMAS) patient-reported outcome measure (PROM) at 12 weeks post surgery. Secondary PROMs include the EQ-5D-5 L questionnaire, return to work and return to driving, with objective outcomes including ankle range of motion. Analysis will be on an intention-to-treat basis. An economic evaluation will be included. The EMADE intervention is a package of care designed to address the detrimental effects of disuse atrophy and joint stiffness. An advantage of the OMAS is the potential of meta-analysis with other designs. Within the economic evaluation, the cost-utility analysis, may be used by commissioners, while the use of patient-relevant outcomes, such as return to work and driving, will ensure that the study remains pertinent to patients and their families. As it is being conducted in the clinical environment, this p-RCT has high external

  3. Perception of health care providers about sexually transmitted infections

    International Nuclear Information System (INIS)

    Khan, A.; Izhar, V.

    2015-01-01

    Sexually transmitted infections represent a global health problem leading to social stigma and early morbidity and mortality. Prior to this study, different health care providers were dealing with sexually transmitted infections with various parameters and were not following the standard regime given by the WHO. The aim of this study was to investigate the perception of health care providers about sexually transmitted infections and its treatment guidelines. Methods: Cross sectional questionnaire based study was conducted from health care providers(specialists, family physicians, homeopaths and others )of Lahore from Jan 2014 to December 2014. Data was collected with consent through convenience purposive sampling of randomly selected 100 specialists, 200 family physicians, 100 homeopaths and 100 others. Trained investigators pre-tested the validity and reliability of the questionnaire before use. Data of response was coded, entered and analyzed using SPSS. Results: Out of 500 practitioners 475 (95%) completed the questionnaire. Those excluded were due to insufficient data in questionnaire. Almost all respondents were aware of STIs and the guidelines and claimed to have decent knowledge. Apart from some disagreement on the user- friendliness and communication facilitating properties, the health care provider's attitude were positive. Conclusion: Overall, all the health care providers knew about sexually transmitted infections. It was the treatment according to the guidelines, in which they differed. Specialists and Family physician in Lahore, Pakistan knew and followed the STIs guidelines while managing the patients. Homeopaths and others were receiving patients and treating most of these infections but were not aware of the standard guidelines yet somehow their patients were treated and satisfied. Enhancing the familiarity of the guidelines among users can result in a positive outcome on the treatment of STIs. (author)

  4. Primary care providers' lived experiences of genetics in practice.

    Science.gov (United States)

    Harding, Brittany; Webber, Colleen; Ruhland, Lucia; Dalgarno, Nancy; Armour, Christine M; Birtwhistle, Richard; Brown, Glenn; Carroll, June C; Flavin, Michael; Phillips, Susan; MacKenzie, Jennifer J

    2018-04-26

    To effectively translate genetic advances into practice, engagement of primary care providers (PCPs) is essential. Using a qualitative, phenomenological methodology, we analyzed key informant interviews and focus groups designed to explore perspectives of urban and rural PCPs. PCPs endorsed a responsibility to integrate genetics into their practices and expected advances in genetic medicine to expand. However, PCPs reported limited knowledge and difficulties accessing resources, experts, and continuing education. Rural practitioners' additional concerns included cost, distance, and poor patient engagement. PCPs' perspectives are crucial to develop relevant educational and systems-based interventions to further expand genetic medicine in primary care.

  5. Mindfulness-based stress reduction added to care as usual for lung cancer patients and/or their partners: A multicentre randomized controlled trial.

    Science.gov (United States)

    Schellekens, M P J; van den Hurk, D G M; Prins, J B; Donders, A R T; Molema, J; Dekhuijzen, R; van der Drift, M A; Speckens, A E M

    2017-12-01

    Lung cancer patients report among the highest distress rates of all cancer patients. Partners report similar distress rates. The present study examined the effectiveness of additional mindfulness-based stress reduction (care as usual [CAU] + MBSR) versus solely CAU to reduce psychological distress in lung cancer patients and/or their partners. We performed a multicentre, parallel-group, randomized controlled trial. Mindfulness-based stress reduction is an 8-week group-based intervention, including mindfulness practice and teachings on stress. Care as usual included anticancer treatment, medical consultations, and supportive care. The primary outcome was psychological distress. Secondary outcomes included quality of life, caregiver burden, relationship satisfaction, mindfulness skills, self-compassion, rumination, and posttraumatic stress symptoms. Outcomes were assessed at baseline, post-intervention, and 3-month follow-up. Linear mixed modeling was conducted on an intention-to-treat sample. Moderation (gender, disease stage, baseline distress, participation with/without partner) and mediation analyses were performed. A total of 31 patients and 21 partners were randomized to CAU + MBSR and 32 patients and 23 partners to CAU. After CAU + MBSR patients reported significantly less psychological distress (p = .008, d = .69) than after CAU. Baseline distress moderated outcome: those with more distress benefitted most from MBSR. Additionally, after CAU + MBSR patients showed more improvements in quality of life, mindfulness skills, self-compassion, and rumination than after CAU. In partners, no differences were found between groups. Our findings suggest that psychological distress in lung cancer patients can be effectively treated with MBSR. No effect was found in partners, possibly because they were more focused on patients' well-being rather than their own. Copyright © 2017 John Wiley & Sons, Ltd.

  6. Holistic health care: Patients' experiences of health care provided by an Advanced Practice Nurse.

    Science.gov (United States)

    Eriksson, Irene; Lindblad, Monica; Möller, Ulrika; Gillsjö, Catharina

    2018-02-01

    Advanced Practice Nurse (APN) is a fairly new role in the Swedish health care system. To describe patients' experiences of health care provided by an APN in primary health care. An inductive, descriptive qualitative approach with qualitative open-ended interviews was chosen to obtain descriptions from 10 participants regarding their experiences of health care provided by an APN. The data were collected during the spring 2012, and a qualitative approach was used for analyze. The APNs had knowledge and skills to provide safe and secure individual and holistic health care with high quality, and a respectful and flexible approach. The APNs conveyed trust and safety and provided health care that satisfied the patients' needs of accessibility and appropriateness in level of care. The APNs way of providing health care and promoting health seems beneficial in many ways for the patients. The individual and holistic approach that characterizes the health care provided by the APNs is a key aspect in the prevailing change of health care practice. The transfer of care and the increasing number of older adults, often with a variety of complex health problems, call for development of the new role in this context. © 2017 The Authors. International Journal of Nursing Practice Published by John Wiley & Sons Australia, Ltd.

  7. The financial impact of deployments on reserve health care providers.

    Science.gov (United States)

    Petinaux, Bruno

    2008-08-01

    This study retrospectively surveyed the financial impact of deployments on 17 U.S. Army Reserve health care providers. Due to multiple mobilizations, 29 separate deployments were reported. The deployments, mostly between 2001 and 2005, typically lasted 3 months during which 86% reported no civilian income and 76% reported no civilian benefits. Solo practice providers reported the greatest financial losses due to continuing financial responsibility related to their civilian practice despite being deployed. Overall, 2 deployments did not change, 9 increased, and 16 decreased the medical officer's income. Two were not reported. In this small retrospective convenience sample study, solo practice U.S. Army Reserve health care providers were found to be at highest risk of financial losses during military deployments. This being said, no price can be put on the privilege of serving our men and women in uniform.

  8. Women's and care providers' perspectives of quality prenatal care: a qualitative descriptive study

    Science.gov (United States)

    2012-01-01

    Background Much attention has been given to the adequacy of prenatal care use in promoting healthy outcomes for women and their infants. Adequacy of use takes into account the timing of initiation of prenatal care and the number of visits. However, there is emerging evidence that the quality of prenatal care may be more important than adequacy of use. The purpose of our study was to explore women's and care providers' perspectives of quality prenatal care to inform the development of items for a new instrument, the Quality of Prenatal Care Questionnaire. We report on the derivation of themes resulting from this first step of questionnaire development. Methods A qualitative descriptive approach was used. Semi-structured interviews were conducted with 40 pregnant women and 40 prenatal care providers recruited from five urban centres across Canada. Data were analyzed using inductive open and then pattern coding. The final step of analysis used a deductive approach to assign the emergent themes to broader categories reflective of the study's conceptual framework. Results The three main categories informed by Donabedian's model of quality health care were structure of care, clinical care processes, and interpersonal care processes. Structure of care themes included access, physical setting, and staff and care provider characteristics. Themes under clinical care processes were health promotion and illness prevention, screening and assessment, information sharing, continuity of care, non-medicalization of pregnancy, and women-centredness. Interpersonal care processes themes were respectful attitude, emotional support, approachable interaction style, and taking time. A recurrent theme woven throughout the data reflected the importance of a meaningful relationship between a woman and her prenatal care provider that was characterized by trust. Conclusions While certain aspects of structure of care were identified as being key dimensions of quality prenatal care, clinical and

  9. KNOWLEDGE AND PRACTICES AMONGST HEALTH CARE PROVIDERS & CARE TAKERS REGARDING MANAGEMENT OF CHILDHOOD DIARRHOEA IN DEMONSTRATION DISTRICTS OF GUJARAT

    Directory of Open Access Journals (Sweden)

    Rupani Mihir

    2015-12-01

    Full Text Available Introduction:Diarrhoea Alleviation through Zinc and ORS Therapy (DAZT project was started in 6 demonstration districtsof Gujarat in 2011. Rationale: In addition to poor feeding/hygiene practices of caretakers, inappropriate prescription from providers and inadequate use of Zinc-ORS are challenges in diarrhoea management. Objectives:To understand prescription practices for childhood diarrhoea, assess knowledge about zinc therapy among health care providers & caretakers in the government/private sectors &assess knowledge about additional information to be provided to caretakersamong health care providers& its practice among care takers. Materials & Methods:Information was collected onstructured questionnaires by interviews of 127care providers&43 care takersin 6 districts.In addition, case records were reviewed for 228 prescriptions – all from government sector. Data collected was entered and analyzedusing Excel. Results:Based on records/interviews, government functionaries dispensed ORS in 97%& zinc in 90% cases of diarrhoea while, private providers prescribed itin 79% &71% respectively. Antibiotics were prescribed in 24% & 59%, anti-amoebic in 20.2% &64.7% in public& private sectors respectively.Knowledge of dosage and duration of zinc therapy was better among public sector providers than private sector ones. Amongst caretakers, 74.4% gave correct dose of zinc to their children but was given for 14 days in 67.4% of cases; common reasons for non-compliance were“improved condition”&“no need to continue”. Foradditional information, such as advice on continued feeding, giving more than usual fluid,hand washing& when to return back to health facility, the responses were better for government providers than private ones. Knowledge about this additional information was also poor amongst care takers. Conclusions:For all the parameters studied, responses were better amongst government providers than those from private sector. Demand

  10. The effect of narrow provider networks on health care use.

    Science.gov (United States)

    Atwood, Alicia; Lo Sasso, Anthony T

    2016-12-01

    Network design is an often overlooked aspect of health insurance contracts. Recent policy factors have resulted in narrower provider networks. We provide plausibly causal evidence on the effect of narrow network plans offered by a large national health insurance carrier in a major metropolitan market. Our econometric design exploits the fact that some firms offer a narrow network plan to their employees and some do not. Our results show that narrow network health plans lead to reductions in health care utilization and spending. We find evidence that narrow networks save money by selecting lower cost providers into the network. Copyright © 2016 Elsevier B.V. All rights reserved.

  11. Primary Care Providers' Perspectives on Errors of Omission.

    Science.gov (United States)

    Poghosyan, Lusine; Norful, Allison A; Fleck, Elaine; Bruzzese, Jean-Marie; Talsma, AkkeNeel; Nannini, Angela

    2017-01-01

    Despite recent focus on patient safety in primary care, little attention has been paid to errors of omission, which represent significant gaps in care and threaten patient safety in primary care but are not well studied or categorized. The purpose of this study was to develop a typology of errors of omission from the perspectives of primary care providers (PCPs) and understand what factors within practices lead to or prevent these omissions. A qualitative descriptive design was used to collect data from 26 PCPs, both physicians and nurse practitioners, from the New York State through individual interviews. One researcher conducted all interviews, which were audiotaped, transcribed verbatim, and analyzed in ATLAS.ti, Berlin by 3 researchers using content analysis. They immersed themselves into data, read transcripts independently, and conducted inductive coding. The final codes were linked to each other to develop the typology of errors of omission and the themes. Data saturation was reached at the 26th interview. PCPs reported that omitting patient teaching, patient followup, emotional support, and addressing mental health needs were the main categories of errors of omission. PCPs perceived that time constraints, unplanned patient visits and emergencies, and administrative burden led to these gaps in care. They emphasized that organizational support and infrastructure, effective teamwork and communication, and preparation for the patient encounter were important safeguards to prevent errors of omission within their practices. Errors of omission are common in primary care and could threaten patient safety. Efforts to eliminate them should focus on strengthening organizational attributes of practices, improving teamwork and communication, and assigning manageable workload to PCPs. Practice and policy change is necessary to address gaps in care and prevent them before they result in patient harm. © Copyright 2017 by the American Board of Family Medicine.

  12. Effect of nurse home visits vs. usual care on reducing intimate partner violence in young high-risk pregnant women: a randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Jamila Mejdoubi

    Full Text Available BACKGROUND: Expectant mothers and mothers of young children are especially vulnerable to intimate partner violence (IPV. The nurse-family partnership (NFP is a home visitation program in the United States effective for the prevention of adverse child health outcomes. Evidence regarding the effect of nurse home visiting on IPV is inconsistent. This study aims to study the effect of VoorZorg, the Dutch NFP, on IPV. METHODS: A random sample of 460 eligible disadvantaged women <26 years, with no previous live births, was randomized. Women in the control group (C; n=223 received usual care; women in the intervention group (I; n=237 received usual care plus nurse home visits periodically during pregnancy and until the child's second birthday. RESULTS: At 32 weeks of pregnancy, women in the intervention group self-reported significantly less IPV victimization than women in the control group in: level 2 psychological aggression (C: 56% vs. I: 39%, physical assault level 1 (C: 58% vs. I: 40% and level 2 (C: 31% vs. I: 20%, and level 1 sexual coercion (C: 16% vs. I: 8%. Furthermore, women in the intervention group reported significantly less IPV perpetration in: level 2 psychological aggression (C: 60% vs. I: 46%, level 1 physical assault (C: 65% vs. I: 52%, and level 1 injury (C: 27% vs. I: 17%. At 24 months after birth, IPV victimization was significantly lower in the intervention group for level 1 physical assault (C: 44% vs. I: 26%, and IPV perpetration was significantly lower for level 1 sexual assault (C: 18% vs. I: 3%. Multilevel analyses showed a significant improvement in IPV victimization and perpetration among women in the intervention group at 24 months after birth. CONCLUSION: VoorZorg, compared with the usual care, is effective in reducing IPV during pregnancy and in the two years after birth among young high-risk women. TRIAL REGISTRATION: Dutch Trial Register NTR854 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=854.

  13. Gatekeepers as Care Providers: The Care Work of Patient-centered Medical Home Clerical Staff.

    Science.gov (United States)

    Solimeo, Samantha L; Ono, Sarah S; Stewart, Kenda R; Lampman, Michelle A; Rosenthal, Gary E; Stewart, Greg L

    2017-03-01

    International implementation of the patient-centered medical home (PCMH) model for delivering primary care has dramatically increased in the last decade. A majority of research on PCMH's impact has emphasized the care provided by clinically trained staff. In this article, we report our ethnographic analysis of data collected from Department of Veterans Affairs staff implementing PACT, the VA version of PCMH. Teams were trained to use within-team delegation, largely accomplished through attention to clinical licensure, to differentiate staff in providing efficient, patient-centered care. In doing so, PACT may reinforce a clinically defined culture of care that countermands PCMH ideals. Such competing rubrics for care are brought into relief through a focus on the care work performed by clerks. Ethnographic analysis identifies clerks' care as a kind of emotional dirty work, signaling important areas for future anthropological study of the relationships among patient-centered care, stigma, and clinical authority. © 2016 by the American Anthropological Association.

  14. Providing primary health care with non-physicians.

    Science.gov (United States)

    Chen, P C

    1984-04-01

    The definition of primary health care is basically the same, but the wide variety of concepts as to the form and type of worker required is largely due to variations in economic, demographic, socio-cultural and political factors. Whatever form it takes, in many parts of the developing world, it is increasingly clear that primary health care must be provided by non-physicians. The reasons for this trend are compelling, yet it is surprisingly opposed by the medical profession in many a developing country. Nonetheless, numerous field trials are being conducted in a variety of situations in several countries around the world. Non-physician primary health care workers vary from medical assistants and nurse practitioners to aide-level workers called village mobilizers, village volunteers, village aides and a variety of other names. The functions, limitations and training of such workers will need to be defined, so that an optimal combination of skills, knowledge and attitudes best suited to produce the desired effect on local health problems may be attained. The supervision of such workers by the physician and other health professionals will need to be developed in the spirit of the health team. An example of the use of non-physicians in providing primary health care in Sarawak is outlined.

  15. Towards culturally competent paediatric oncology care. A qualitative study from the perspective of care providers.

    Science.gov (United States)

    Suurmond, J; Lieveld, A; van de Wetering, M; Schouten-van Meeteren, A Y N

    2017-11-01

    In order to gain more insight on the influence of ethnic diversity in paediatric cancer care, the perspectives of care providers were explored. Semi-structured interviews were conducted among 12 paediatric oncologists and 13 nurses of two different paediatric oncology wards and were analysed using a framework method. We found that care providers described the contact with Turkish and Moroccan parents as more difficult. They offered two reasons for this: (1) language barriers between care provider and parents hindered the exchange of information; (2) cultural barriers between care provider and parents about sharing the diagnosis and palliative perspective hindered communication. Care providers reported different solutions to deal with these barriers, such as using an interpreter and improving their cultural knowledge about their patients. They, however, were not using interpreters sufficiently and were unaware of the importance of eliciting parents' perspectives. Communication techniques to overcome dilemmas between parents and care providers were not used and care providers were unaware of stereotypes and prejudice. Care providers should be offered insight in cultural barriers they are unaware of. Training in cultural competence might be a possibility to overcome manifest barriers. © 2017 John Wiley & Sons Ltd.

  16. Provider Tools for Advance Care Planning and Goals of Care Discussions: A Systematic Review.

    Science.gov (United States)

    Myers, Jeff; Cosby, Roxanne; Gzik, Danusia; Harle, Ingrid; Harrold, Deb; Incardona, Nadia; Walton, Tara

    2018-01-01

    Advance care planning and goals of care discussions involve the exploration of what is most important to a person, including their values and beliefs in preparation for health-care decision-making. Advance care planning conversations focus on planning for future health care, ensuring that an incapable person's wishes are known and can guide the person's substitute decision maker for future decision-making. Goals of care discussions focus on preparing for current decision-making by ensuring the person's goals guide this process. To provide evidence regarding tools and/or practices available for use by health-care providers to effectively facilitate advance care planning conversations and/or goals of care discussions. A systematic review was conducted focusing on guidelines, randomized trials, comparative studies, and noncomparative studies. Databases searched included MEDLINE, EMBASE, and the proceedings of the International Advance Care Planning Conference and the American Society of Clinical Oncology Palliative Care Symposium. Although several studies report positive findings, there is a lack of consistent patient outcome evidence to support any one clinical tool for use in advance care planning or goals of care discussions. Effective advance care planning conversations at both the population and the individual level require provider education and communication skill development, standardized and accessible documentation, quality improvement initiatives, and system-wide coordination to impact the population level. There is a need for research focused on goals of care discussions, to clarify the purpose and expected outcomes of these discussions, and to clearly differentiate goals of care from advance care planning.

  17. Economic evaluation of stepped-care versus usual care for depression and anxiety in older adults with vision impairment : randomized controlled trial

    NARCIS (Netherlands)

    van der Aa, Hilde P A; van Rens, Ger H M B; Bosmans, Judith E; Comijs, Hannie C; van Nispen, Ruth M A

    2017-01-01

    BACKGROUND: A stepped-care program was found effective in preventing depressive and anxiety disorders in older adults with vision impairment. However, before a decision can be made about implementation, the cost-effectiveness of this program should be investigated. Therefore, we aimed to compare the

  18. The effect of integrated emotion-oriented care versus usual care on elderly persons with dementia in the nursing home and on nursing assistants: a randomized clinical trial

    NARCIS (Netherlands)

    Finnema, E.J.; Dr�es, R.M.; Ettema, T.P.; Ooms, M.E.; Adèr, H.J.; Ribbe, M.W.; van Tilburg, W.

    2005-01-01

    Objectives: To examine the effect of integrated emotion-oriented care on nursing home residents with dementia and nursing assistants. Design: A multi-site randomized clinical trial with matched groups, and measurements at baseline and after seven months. Setting: Sixteen psychogeriatric wards in

  19. The effect of integrated emotion-oriented care versus usual care on elderly persons with dementia in the nursing home and on nursing assistants: a randomized clinical trial

    NARCIS (Netherlands)

    Finnema, E.J.; Dr�es, R.M.; Ettema, T.P.; Ooms, M.E.; Adèr, H.J.; Ribbe, M.W.; Tilburg, van W.

    2005-01-01

    OBJECTIVES: To examine the effect of integrated emotion-oriented care on nursing home residents with dementia and nursing assistants. DESIGN: A multi-site randomized clinical trial with matched groups, and measurements at baseline and after seven months. SETTING: Sixteen psychogeriatric wards in

  20. Barriers and facilitators for the implementation of an online clinical health community in addition to usual fertility care: a cross-sectional study.

    Science.gov (United States)

    Aarts, Johanna W M; Faber, Marjan J; den Boogert, Anne G; Cohlen, Ben J; van der Linden, Paul J Q; Kremer, Jan A M; Nelen, Willianne L D M

    2013-08-30

    Online health communities are becoming more popular in health care. Patients and professionals can communicate with one another online, patients can find peer support, and professionals can use it as an additional information channel to their patients. However, the implementation of online health communities into daily practice is challenging. These challenges relate to the fact that patients need to be activated to (1) become a member (ie, subscription) and (2) participate actively within the community before any effect can be expected. Therefore, we aimed at answering 2 research questions: (1) what factors are associated with subscription to an online health community, and (2) which are associated with becoming an active participant within an online health community. To identify barriers and facilitators as perceived by patients for the implementation of an online health community. We performed a cross-sectional study. Three Dutch fertility clinics (2 IVF-licensed) offered their patients a secure online clinical health community through which clinicians can provide online information and patients can ask questions to the medical team or share experiences and find support from peers. We randomly selected and invited 278 men and women suffering from infertility and attending 1 of the participating clinics. Participants filled out a questionnaire about their background characteristics and current use of the online community. Possible barriers and facilitators were divided into 2 parts: (1) those for subscription to the community, and (2) those for active participation in the community. We performed 2 multivariate logistic regression analyses to calculate determinants for both subscription and active participation. Subscription appeared to be associated with patients' background characteristics (eg, gender, treatment phase), intervention-related facilitators (odds ratio [OR] 2.45, 95% CI 1.14-5.27), and patient-related barriers (OR 0.20, 95% CI 0.08-0.54), such as

  1. Barriers to providing maternity care to women with physical disabilities: Perspectives from health care practitioners.

    Science.gov (United States)

    Mitra, Monika; Smith, Lauren D; Smeltzer, Suzanne C; Long-Bellil, Linda M; Sammet Moring, Nechama; Iezzoni, Lisa I

    2017-07-01

    Women with physical disabilities are known to experience disparities in maternity care access and quality, and communication gaps with maternity care providers, however there is little research exploring the maternity care experiences of women with physical disabilities from the perspective of their health care practitioners. This study explored health care practitioners' experiences and needs around providing perinatal care to women with physical disabilities in order to identify potential drivers of these disparities. We conducted semi-structured telephone interviews with 14 health care practitioners in the United States who provide maternity care to women with physical disabilities, as identified by affiliation with disability-related organizations, publications and snowball sampling. Descriptive coding and content analysis techniques were used to develop an iterative code book related to barriers to caring for this population. Public health theory regarding levels of barriers was applied to generate broad barrier categories, which were then analyzed using content analysis. Participant-reported barriers to providing optimal maternity care to women with physical disabilities were grouped into four levels: practitioner level (e.g., unwillingness to provide care), clinical practice level (e.g., accessible office equipment like adjustable exam tables), system level (e.g., time limits, reimbursement policies), and barriers relating to lack of scientific evidence (e.g., lack of disability-specific clinical data). Participants endorsed barriers to providing optimal maternity care to women with physical disabilities. Our findings highlight the needs for maternity care practice guidelines for women with physical disabilities, and for training and education regarding the maternity care needs of this population. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. The second Symptom Management Research Trial in Oncology (SMaRT Oncology-2): a randomised trial to determine the effectiveness and cost-effectiveness of adding a complex intervention for major depressive disorder to usual care for cancer patients.

    Science.gov (United States)

    Walker, Jane; Cassidy, Jim; Sharpe, Michael

    2009-03-30

    Depression Care for People with Cancer is a complex intervention delivered by specially trained cancer nurses, under the supervision of a psychiatrist. It is given as a supplement to the usual care for depression, which patients receive from their general practitioner and cancer service. In a 'proof of concept' trial (Symptom Management Research Trials in Oncology-1) Depression Care for People with Cancer improved depression more than usual care alone. The second Symptom Management Research Trial in Oncology (SMaRT Oncology-2 Trial) will test its effectiveness and cost-effectiveness in a 'real world' setting. A two arm parallel group multi-centre randomised controlled trial. TRIAL PROCEDURES: 500 patients will be recruited through established systematic Symptom Monitoring Services, which screen patients for depression. Patients will have: a diagnosis of cancer (of various types); an estimated life expectancy of twelve months or more and a diagnosis of Major Depressive Disorder. Patients will be randomised to usual care or usual care plus Depression Care for People with Cancer. Randomisation will be carried out by telephoning a secure computerised central randomisation system or by using a secure web interface. The primary outcome measure is 'treatment response' measured at 24 week outcome data collection. 'Treatment response' will be defined as a reduction of 50% or more in the patient's baseline depression score, measured using the 20-item Symptom Checklist (SCL-20D). Secondary outcomes include remission of major depressive disorder, depression severity and patients' self-rated improvement of depression. Current controlled trials ISRCTN40568538 TRIAL HYPOTHESES: (1) Depression Care for People with Cancer as a supplement to usual care will be more effective than usual care alone in achieving a 50% reduction in baseline SCL-20D score at 24 weeks. (2) Depression Care for People with Cancer as a supplement to usual care will cost more than usual care alone but will be

  3. Effectiveness of app-based self-acupressure for women with menstrual pain compared to usual care: a randomized pragmatic trial.

    Science.gov (United States)

    Blödt, Susanne; Pach, Daniel; Eisenhart-Rothe, Sanna von; Lotz, Fabian; Roll, Stephanie; Icke, Katja; Witt, Claudia M

    2018-02-01

    Primary dysmenorrhea is common among women of reproductive age. Nonsteroidal anti-inflammatory drugs and oral contraceptives are effective treatments, although the failure rate is around 20% to 25%. Therefore additional evidence-based treatments are needed. In recent years, the use of smartphone applications (apps) has increased rapidly and may support individuals in self-management strategies. We aimed to investigate the effectiveness of app-based self-acupressure in women with menstrual pain. A 2-armed, randomized, pragmatic trial was conducted from December 2012 to April 2015 with recruitment until August 2014 in Berlin, Germany, among women aged 18 to 34 years with self-reported cramping pain of 6 or more on a numeric rating scale (NRS) for the worst pain intensity during the previous menstruation. After randomization, women performed either app-based self-acupressure (n = 111) or followed usual care only (n = 110) for 6 consecutive menstruation cycles. The primary outcome was the mean pain intensity (NRS 0-10) on the days with pain during the third menstruation. Secondary outcomes included worst pain intensity during menstruation, duration of pain, 50% responder rates (reduction of mean pain by at least 50%), medication intake, sick leave days, and body efficacy expectation assessed at the first, second, third, and sixth menstruation cycles. We included 221 women (mean age, 24.0 years; standard deviation [SD], 3.6 years). The mean pain intensity difference during the third menstruation was statistically significant in favor of acupressure (acupressure: 4.4; 95% confidence interval [CI], 4.0-4.7; usual care 5.0; 95% CI, 4.6-5.3; mean difference -0.6; 95% CI, - 1.2 to -0.1; P = .026). At the sixth cycle, the mean difference between the groups (-1.4; 95% CI, -2.0 to -0.8; P 0.5; 95% CI, 0.3-0.9] and 0.3 (95% CI, 0.2-0.5) were lower in the acupressure group. At the third cycle, hormonal contraceptive use was more common in the usual care group than in

  4. Comparative effectiveness of vildagliptin in combination with other oral anti-diabetes agents in usual-care conditions: the EDGE-Latin America study.

    Science.gov (United States)

    Mendivil, Carlos O; Márquez-Rodríguez, Eduardo; Angel, Iván D; Paz, Gustavo; Rodríguez, Cruz; Almada, Jorge; Szyskowsky, Ofelia

    2014-09-01

    To assess the proportion of patients on vildagliptin add-on dual therapy who respond to treatment over a 12 month follow-up, relative to comparator oral anti-diabetes dual therapy, in a usual care setting. Participants were patients with type 2 diabetes (T2DM) aged 18 years and older from 311 centers in Argentina, Colombia, Ecuador, Mexico and Venezuela. Patients were taking monotherapy with an oral anti-diabetes drug (OAD), and were prescribed a new add-on OAD based on the judgment of their personal physician. According to this choice, patients were assigned to one of the two cohorts: vildagliptin or comparator OADs. The primary endpoint was the proportion of patients achieving an A1c drop >0.3% without edema, hypoglycemia, weight gain or discontinuation due to gastrointestinal (GI) events. The secondary endpoint was the proportion of patients with baseline A1c ≥7% who reached the goal of an A1c vildagliptin cohort and 771 in the comparator cohort. The proportion of patients reaching the primary endpoint was higher in the vildagliptin cohort (60.3%) than the comparator cohort (50.7%), OR 1.48 (95% CI: 1.25-1.73). The same was observed for the secondary endpoint (44.8 versus 33.1%) OR 1.64 (95% CI: 1.37-1.98). The incidence of adverse events was low and similar between treatment cohorts. In a usual care setting, patients treated with a vildagliptin combination succeeded in lowering A1c to <7%, without weight gain, hypoglycemia or peripheral edema more often than patients treated with comparator combinations, without increased risk of adverse events. Key limitations are the observational nature of the study and its relatively limited 12 month timeframe.

  5. Effectiveness of manual therapy compared to usual care by the general practitioner for chronic tension-type headache: design of a randomised clinical trial

    Directory of Open Access Journals (Sweden)

    Dekker Joost

    2009-02-01

    Full Text Available Abstract Background Patients with Chronic Tension Type Headache (CTTH report functional and emotional impairments (loss of workdays, sleep disturbances, emotional well-being and are at risk for overuse of medication. Manual therapy may improve symptoms through mobilisation of the spine, correction of posture, and training of cervical muscles. We present the design of a randomised clinical trial (RCT evaluating the effectiveness of manual therapy (MT compared to usual care by the general practitioner (GP in patients with CTTH. Methods and design Patients are eligible for participation if they present in general practice with CTTH according to the classification of the International Headache Society (IHS. Participants are randomised to either usual GP care according to the national Dutch general practice guidelines for headache, or manual therapy, consisting of mobilisations (high- and low velocity techniques, exercise therapy for the cervical and thoracic spine and postural correction. The primary outcome measures are the number of headache days and use of medication. Secondary outcome measures are severity of headache, functional status, sickness absence, use of other healthcare resources, active cervical range of motion, algometry, endurance of the neckflexor muscles and head posture. Follow-up assessments are conducted after 8 and 26 weeks. Discussion This is a pragmatic trial in which interventions are offered as they are carried out in everyday practice. This increases generalisability of results, but blinding of patients, GPs and therapists is not possible. The results of this trial will contribute to clinical decision making of the GP regarding referral to manual therapy in patients with chronic tension headache.

  6. Why do health and social care providers co-operate?

    Science.gov (United States)

    van Raak, Arno; Paulus, Aggie; Mur-Veeman, Ingrid

    2005-09-28

    Within Europe, although there are numerous examples of poor co-ordination in the delivery of integrated care, many providers do co-operate. We wanted to know why providers are moved to co-operate. In terms of systematic research, this is a new field; researchers have only begun to theorise about the rationales for co-operation. Practically, the issue of achieving co-operation attracts much attention from policymakers. Understanding the reasons for co-operation is a prerequisite for developing effective policy in support of integrated care. Our aim is to explore the comparative validity of different theoretical perspectives on the reasons for co-operation, to indicate directions for further study and for policy making. We used data from three successive studies to perform pattern matching with six established theoretical perspectives: transaction costs economics, strategic choice theory, resource dependence theory, learning theory, stakeholder theory and institutional theory. Insights from the studies were compared for validating purposes (triangulation). The first study concerned the evaluation of the Dutch 'National Home Health Care Programme' according to the case study methodology. The second and third studies were surveys among project directors: questionnaires were based on the concepts derived from the first study. Researchers should combine normative institutional theory, resource dependence theory and stakeholder theory into one perspective, in order to study relationship formation in health and social care. The concept of institutions (rules) is the linchpin between the theories. Policy makers must map the institutions of stakeholders and enable integrated care policy to correspond with these institutions as much as possible.

  7. Exploring Health Care Providers' Views About Initiating End-of-Life Care Communication.

    Science.gov (United States)

    Nedjat-Haiem, Frances R; Carrion, Iraida V; Gonzalez, Krystana; Ell, Kathleen; Thompson, Beti; Mishra, Shiraz I

    2017-05-01

    Numerous factors impede effective and timely end-of-life (EOL) care communication. These factors include delays in communication until patients are seriously ill and/or close to death. Gaps in patient-provider communication negatively affect advance care planning and limit referrals to palliative and hospice care. Confusion about the roles of various health care providers also limits communication, especially when providers do not coordinate care with other health care providers in various disciplines. Although providers receive education regarding EOL communication and care coordination, little is known about the roles of all health care providers, including nonphysician support staff working with physicians to discuss the possibility of dying and help patients prepare for death. This study explores the perspectives of physicians, nurses, social workers, and chaplains on engaging seriously ill patients and families in EOL care communication. Qualitative data were from 79 (medical and nonmedical) providers practicing at 2 medical centers in Central Los Angeles. Three themes that describe providers' perceptions of their roles and responsibility in talking with seriously ill patients emerged: (1) providers' roles for engaging in EOL discussions, (2) responsibility of physicians for initiating and leading discussions, and (3) need for team co-management patient care. Providers highlighted the importance of beginning discussions early by having physicians lead them, specifically due to their medical training and need to clarify medical information regarding patients' prognosis. Although physicians are a vital part of leading EOL communication, and are at the center of communication of medical information, an interdisciplinary approach that involves nurses, social workers, and chaplains could significantly improve patient care.

  8. Do public nursing home care providers deliver higher quality than private providers? Evidence from Sweden.

    Science.gov (United States)

    Winblad, Ulrika; Blomqvist, Paula; Karlsson, Andreas

    2017-07-14

    Swedish nursing home care has undergone a transformation, where the previous virtual public monopoly on providing such services has been replaced by a system of mixed provision. This has led to a rapidly growing share of private actors, the majority of which are large, for-profit firms. In the wake of this development, concerns have been voiced regarding the implications for care quality. In this article, we investigate the relationship between ownership and care quality in nursing homes for the elderly by comparing quality levels between public, for-profit, and non-profit nursing home care providers. We also look at a special category of for-profit providers; private equity companies. The source of data is a national survey conducted by the Swedish National Board of Health and Welfare in 2011 at 2710 nursing homes. Data from 14 quality indicators are analyzed, including structure and process measures such as staff levels, staff competence, resident participation, and screening for pressure ulcers, nutrition status, and risk of falling. The main statistical method employed is multiple OLS regression analysis. We differentiate in the analysis between structural and processual quality measures. The results indicate that public nursing homes have higher quality than privately operated homes with regard to two structural quality measures: staffing levels and individual accommodation. Privately operated nursing homes, on the other hand, tend to score higher on process-based quality indicators such as medication review and screening for falls and malnutrition. No significant differences were found between different ownership categories of privately operated nursing homes. Ownership does appear to be related to quality outcomes in Swedish nursing home care, but the results are mixed and inconclusive. That staffing levels, which has been regarded as a key quality indicator in previous research, are higher in publicly operated homes than private is consistent with earlier

  9. Interactions between patients and dental care providers: does gender matter?

    Science.gov (United States)

    Inglehart, Marita R

    2013-04-01

    Research findings concerning the role of gender in patient-physician interactions can inform considerations about the role of gender in patient-dental care provider interactions. Medical research showed that gender differences in verbal and nonverbal communication in medical settings exist and that they affect the outcomes of these interactions. The process of communication is shaped by gender identities, gender stereotypes, and attitudes. Future research needs to consider the cultural complexity and diversity in which gender issues are embedded and the degree to which ongoing value change will shape gender roles and in turn interactions between dental patients and their providers. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. Collaboration of midwives in primary care midwifery practices with other maternity care providers.

    Science.gov (United States)

    Warmelink, J Catja; Wiegers, Therese A; de Cock, T Paul; Klomp, Trudy; Hutton, Eileen K

    2017-12-01

    Inter-professional collaboration is considered essential in effective maternity care. National projects are being undertaken to enhance inter-professional relationships and improve communication between all maternity care providers in order to improve the quality of maternity care in the Netherlands. However, little is known about primary care midwives' satisfaction with collaboration with other maternity care providers, such as general practitioners, maternity care assistance organisations (MCAO), maternity care assistants (MCA), obstetricians, clinical midwives and paediatricians. More insight is needed into the professional working relations of primary care midwives in the Netherlands before major changes are made OBJECTIVE: To assess how satisfied primary care midwives are with collaboration with other maternity care providers and to assess the relationship between their 'satisfaction with collaboration' and personal and work-related characteristics of the midwives, their attitudes towards their work and collaboration characteristics (accessibility). The aim of this study was to provide insight into the professional working relations of primary care midwives in the Netherlands. Our descriptive cross-sectional study is part of the DELIVER study. Ninety nine midwives completed a written questionnaire in May 2010. A Friedman ANOVA test assessed differences in satisfaction with collaboration with six groups of maternity care providers. Bivariate analyses were carried out to assess the relationship between satisfaction with collaboration and personal and work-related characteristics of the midwives, their attitudes towards their work and collaboration characteristics. Satisfaction experienced by primary care midwives when collaborating with the different maternity care providers varies within and between primary and secondary/tertiary care. Interactions with non-physicians (clinical midwives and MCA(O)) are ranked consistently higher on satisfaction compared with

  11. Time providing care outside visits in a home-based primary care program.

    Science.gov (United States)

    Pedowitz, Elizabeth J; Ornstein, Katherine A; Farber, Jeffrey; DeCherrie, Linda V

    2014-06-01

    To assess how much time physicians in a large home-based primary care (HBPC) program spend providing care outside of home visits. Unreimbursed time and patient and provider-related factors that may contribute to that time were considered. Mount Sinai Visiting Doctors (MSVD) providers filled out research forms for every interaction involving care provision outside of home visits. Data collected included length of interaction, mode, nature, and with whom the interaction was for 3 weeks. MSVD, an academic home-visit program in Manhattan, New York. All primary care physicians (PCPs) in MSVD (n = 14) agreed to participate. Time data were analyzed using a comprehensive estimate and conservative estimates to quantify unbillable time. Data on 1,151 interactions for 537 patients were collected. An average 8.2 h/wk was spent providing nonhome visit care for a full-time provider. Using the most conservative estimates, 3.6 h/wk was estimated to be unreimbursed per full-time provider. No significant differences in interaction times were found between patients with and without dementia, new and established patients, and primary-panel and covered patients. Home-based primary care providers spend substantial time providing care outside home visits, much of which goes unrecognized in the current reimbursement system. These findings may help guide practice development and creation of new payment systems for HBPC and similar models of care. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  12. Customer assessment of long-term care pharmacy provider services.

    Science.gov (United States)

    Clark, Thomas R

    2008-09-01

    Assess performance of long-term care pharmacy providers on key services offered to nursing facilities. Cross-sectional; nursing facility team. Random phone survey of nursing facility team members. 485 nursing facility team members (practicing in nursing facilities, interacting with > or = 1 consultant pharmacist); 46 members excluded, unable to identify facility's pharmacy provider. Directors of nursing, medical directors, and administrators were asked to rate long-term care pharmacy provider performance of eight commonly offered pharmacy services. All groups evaluated pharmacy provider performance of these services using a five-point scale. Results are broken down by employer type. Average rating for eight pharmacy services was 3.64. Top two services: "Labeling medications accurately" ranked in top 1-2 services for all groups (combined rating of 3.97) and "Provides medication administration system" ranked in top 1-3 services for all groups (combined rating of 3.95). One service, "Provides educational inservices," ranked lowest for all groups (combined rating of 3.54). In general, when looking at the eight services in combination for all providers, all services were ranked between Good and Very Good (average score of 3.64). Therefore, while the pharmacy provider is performing above average for these services, there is room for improvement in all of these services. These results can be used as a benchmark. Detailed data results and sample surveys are available online at www.ascp.com/supplements. These surveys can be used by the pharmacy provider to solicit assessments from their own facilities on these services.

  13. Threading the cloak: palliative care education for care providers of adolescents and young adults with cancer.

    Science.gov (United States)

    Wiener, Lori; Weaver, Meaghann Shaw; Bell, Cynthia J; Sansom-Daly, Ursula M

    2015-01-09

    Medical providers are trained to investigate, diagnose, and treat cancer. Their primary goal is to maximize the chances of curing the patient, with less training provided on palliative care concepts and the unique developmental needs inherent in this population. Early, systematic integration of palliative care into standard oncology practice represents a valuable, imperative approach to improving the overall cancer experience for adolescents and young adults (AYAs). The importance of competent, confident, and compassionate providers for AYAs warrants the development of effective educational strategies for teaching AYA palliative care. Just as palliative care should be integrated early in the disease trajectory of AYA patients, palliative care training should be integrated early in professional development of trainees. As the AYA age spectrum represents sequential transitions through developmental stages, trainees experience changes in their learning needs during their progression through sequential phases of training. This article reviews unique epidemiologic, developmental, and psychosocial factors that make the provision of palliative care especially challenging in AYAs. A conceptual framework is provided for AYA palliative care education. Critical instructional strategies including experiential learning, group didactic opportunity, shared learning among care disciplines, bereaved family members as educators, and online learning are reviewed. Educational issues for provider training are addressed from the perspective of the trainer, trainee, and AYA. Goals and objectives for an AYA palliative care cancer rotation are presented. Guidance is also provided on ways to support an AYA's quality of life as end of life nears.

  14. Effectiveness of rehabilitation after a total hip arthroplasty: a protocol for an observational study for the comparison of usual care in the Netherlands versus Germany.

    Science.gov (United States)

    Seeber, Gesine H; Wijnen, Annet; Lazovic, Djordje; Bulstra, Sjoerd K; Dietz, Günter; van Lingen, Christiaan P; Stevens, Martin

    2017-08-11

    Osteoarthritis is the most common joint disorder worldwide. Total hip arthroplasty (THA) is considered one of the most effective treatments for end-stage hip osteoarthritis. The number of THAs is expected to increase dramatically in the coming decades. Usual postoperative rehabilitation after primary THA differs between the German and the Dutch system. In the Netherlands, patients undergo fast-track surgery and are discharged into their home environment within a few days without receiving any aftercare. In Germany, patients stay in the hospital for about 12 days before being transferred to a rehabilitation centre for a period of 3 weeks. The superficially more cost-effective Dutch system of usual care after THA is judged critically in both countries due to suboptimal rehabilitation outcomes. The aim of this study is therefore to compare the Dutch with the German usual care rehabilitation after primary THA. It is hypothesised that the German procedure is more effective in terms of functional outcomes and patient satisfaction than the Dutch procedure and that in the long run the German approach is more cost-effective than the Dutch system. Medical effectiveness will be assessed at four different time points by means of patient self-reported questionnaires and functional tests. Assessments include the Hip disability and Osteoarthritis Outcome Score, Patient Acceptable Symptom State, Short Form 36, EuroQol 5 Dimensions 3 Level Questionnaire, Timed Up & Go Test and Five Times Sit-to-Stand Test. Additionally, long-term economic aspects in both countries will be assessed from a societal perspective, to get a first impression on whether cutting costs for rehabilitation, as practised in the Netherlands, really disburdens the healthcare system efficiently. The study is approved by the Institutional Review Boards of both University Medical Center Groningen (METc2015/483) and Hannover Medical School (no 2874-2015) and will be conducted according to the principles of the

  15. Kabuki syndrome: a challenge for the primary care provider.

    Science.gov (United States)

    Crane, Bonnie; Alpert, Patricia T; Cyrkiel, Dianne; Jauregui, Alan

    2013-10-01

    Using a case format, the pathogenesis, clinical manifestations, diagnosis, and management of Kabuki syndrome, a rare genetic condition, is presented. Nurse practitioners (NPs) may encounter patients presenting to the primary care setting with this rare syndrome; understanding this condition may help them to better care for these patients. A case presentation of a pediatric patient supported by the currently available literature from multiple health and medial databases. Kabuki syndrome is a rare phenomenon that occurs in 1 in every 32,000 births. A diagnosis of this syndrome may take several months to years because there are no specific tests, and the physical features may be subtle at birth, becoming more pronounced over a period of time during childhood. The degree of disease severity varies widely. Understanding this syndrome increases the NP's ability to provide primary care to affected patients and their families. Management of this condition requires the NP take on the role of gatekeeper, so timely coordination of specialty or subspecialty services is provided. Special consideration should be given to monitoring caregiver fatigue and impact on siblings so family members can be directed to the appropriate support services. ©2013 The Author(s) ©2013 American Association of Nurse Practitioners.

  16. Predictors of stethoscope disinfection among pediatric health care providers.

    Science.gov (United States)

    Muniz, Jeanette; Sethi, Rosh K V; Zaghi, Justin; Ziniel, Sonja I; Sandora, Thomas J

    2012-12-01

    Stethoscopes are contaminated with bacteria, but predictors of stethoscope disinfection frequency are unknown. We sought to describe health care provider stethoscope disinfection attitudes and practices and determine predictors of frequent disinfection. We used an anonymous online survey of nurses, nurse practitioners, and physicians at a pediatric hospital. We assessed frequency and methods of disinfection, perceptions of contamination, and barriers to disinfection. Multivariate logistic regression models were used to identify independent predictors of disinfecting after every use. One thousand four hundred one respondents completed the survey: 76% believed that infection transmission occurs via stethoscopes, but only 24% reported disinfecting after every use. In multivariate analyses, belief that infection transmission occurs via stethoscopes significantly increased the odds of disinfection after every use (odds ratio [OR], 2.06 [95% confidence interval (CI): 1.38-3.06]). The odds of disinfection after every use were significantly decreased in those who perceived the following barriers: lack of time (OR, 0.31 [95% CI: 0.18-0.54]), lack of access to disinfection material (OR, 0.41 [95% CI: 0.29-0.57]), or lack of visual reminders to disinfect (OR, 0.22 [95% CI: 0.14-0.34]). Only a minority of pediatric health care providers reported disinfecting their stethoscopes after every use. Increasing access to disinfection materials and visual reminders in health care facilities may improve stethoscope disinfection practices. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  17. Long-term cost-effectiveness of collaborative care (vs usual care) for people with depression and comorbid diabetes or cardiovascular disease: a Markov model informed by the COINCIDE randomised controlled trial.

    Science.gov (United States)

    Camacho, Elizabeth M; Ntais, Dionysios; Coventry, Peter; Bower, Peter; Lovell, Karina; Chew-Graham, Carolyn; Baguley, Clare; Gask, Linda; Dickens, Chris; Davies, Linda M

    2016-10-07

    To evaluate the long-term cost-effectiveness of collaborative care (vs usual care) for treating depression in patients with diabetes and/or coronary heart disease (CHD). 36 primary care general practices in North West England. 387 participants completed baseline assessment (collaborative care: 191; usual care: 196) and full or partial 4-month follow-up data were captured for 350 (collaborative care: 170; usual care: 180). 62% of participants were male, 14% were non-white. Participants were aged ≥18 years, listed on a Quality and Outcomes Framework register for CHD and/or type 1 or 2 diabetes mellitus, with persistent depressive symptoms. Patients with psychosis or type I/II bipolar disorder, actively suicidal, in receipt of services for substance misuse, or already in receipt of psychological therapy for depression were excluded. Collaborative care consisted of evidence-based low-intensity psychological treatments, delivered over 3 months and case management by a practice nurse and a Psychological Well Being Practitioner. As planned, the primary measure of cost-effectiveness was the incremental cost-effectiveness ratio (cost per quality-adjusted life year (QALY)). A Markov model was constructed to extrapolate the trial results from short-term to long-term (24 months). The mean cost per participant of collaborative care was £317 (95% CI 284 to 350). Over 24 months, it was estimated that collaborative care was associated with greater healthcare usage costs (net cost £674 (95% CI -30 953 to 38 853)) and QALYs (net QALY gain 0.04 (95% CI -0.46 to 0.54)) than usual care, resulting in a cost per QALY gained of £16 123, and a likelihood of being cost-effective of 0.54 (willingness to pay threshold of £20 000). Collaborative care is a potentially cost-effective long-term treatment for depression in patients with comorbid physical and mental illness. The estimated cost per QALY gained was below the threshold recommended by English decision

  18. Health Care Resource Utilization for Outpatient Cardiovascular Disease and Diabetes Care Delivery Among Advanced Practice Providers and Physician Providers in Primary Care.

    Science.gov (United States)

    Virani, Salim S; Akeroyd, Julia M; Ramsey, David J; Deswal, Anita; Nasir, Khurram; Rajan, Suja S; Ballantyne, Christie M; Petersen, Laura A

    2017-10-10

    Although effectiveness of diabetes or cardiovascular disease (CVD) care delivery between physicians and advanced practice providers (APPs) has been shown to be comparable, health care resource utilization between these 2 provider types in primary care is unknown. This study compared health care resource utilization between patients with diabetes or CVD receiving care from APPs or physicians. Diabetes (n = 1,022,588) or CVD (n = 1,187,035) patients with a primary care visit between October 2013 and September 2014 in 130 Veterans Affairs facilities were identified. Using hierarchical regression adjusting for covariates including patient illness burden, the authors compared number of primary or specialty care visits and number of lipid panels and hemoglobinA1c (HbA1c) tests among diabetes patients, and number of primary or specialty care visits and number of lipid panels and cardiac stress tests among CVD patients receiving care from physicians and APPs. Physicians had significantly larger patient panels compared with APPs. In adjusted analyses, diabetes patients receiving care from APPs received fewer primary and specialty care visits and a greater number of lipid panels and HbA1c tests compared with patients receiving care from physicians. CVD patients receiving care from APPs received more frequent lipid testing and fewer primary and specialty care visits compared with those receiving care from physicians, with no differences in the number of stress tests. Most of these differences, although statistically significant, were numerically small. Health care resource utilization among diabetes or CVD patients receiving care from APPs or physicians appears comparable, although physicians work with larger patient panels.

  19. Role of nursing leadership in providing compassionate care.

    Science.gov (United States)

    Quinn, Barry

    2017-12-13

    This article encourages nurses to explore the concept of leadership in the constantly changing field of health and social care. All nurses have an important role in leadership, and they should consider what type of leader they want to be and what leadership skills they might wish to develop. This article examines what leadership might involve, exploring various leadership styles and characteristics and how these could be applied in nurses' practice. A core component of nursing and nursing leadership is the ability to provide compassionate care. This could correspond with the idea of servant leadership, an approach that moves the leader from a position of power to serving the team and supporting individuals to develop their potential. ©2017 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

  20. Randomized comparison of a multidisciplinary job-retention vocational rehabilitation program with usual outpatient care in patients with chronic arthritis at risk for job loss.

    Science.gov (United States)

    de Buck, Petronella D M; le Cessie, Saskia; van den Hout, Wilbert B; Peeters, Andreas J; Ronday, Herman K; Westedt, Marie-Louise; Breedveld, Ferdinand C; Vliet Vlieland, Theodora P M

    2005-10-15

    Work disability is a major consequence of inflammatory rheumatic conditions. Evidence regarding the effectiveness of interventions aimed at the prevention or reduction of work disability in rheumatic diseases is limited. We conducted a randomized controlled trial to investigate the effectiveness of a multidisciplinary job-retention vocational rehabilitation (VR) program in patients with a rheumatic condition who were at risk for job loss. A total of 140 patients with a chronic rheumatic condition were randomly assigned to either a multidisciplinary job-retention VR program (n = 74) or usual outpatient care (UC) (n = 66). Patients in the VR group were assessed and guided by a multidisciplinary team, whereas patients in the UC group received care as initiated by their rheumatologist, supplemented with written information. The main outcome measure was the occurrence of job loss (complete work disability or unemployment); additional outcome measures included job satisfaction, pain, functional status, emotional status, and quality of life. There was no difference between the 2 groups regarding the proportion of patients having lost their job at any time point, with 24% and 23% of the patients in the VR and UC groups, respectively, having lost their job after 24 months. Over the total period of 24 months, patients in the VR group had a significantly greater improvement of the fatigue visual analog scale and of emotional status (all P values job-retention VR program did not reduce the risk of job loss but improved fatigue and mental health in patients with chronic rheumatic diseases at risk for job loss.

  1. Geriatric care: ways and means of providing comfort.

    Science.gov (United States)

    Ribeiro, Patricia Cruz Pontifice Sousa Valente; Marques, Rita Margarida Dourado; Ribeiro, Marta Pontifice

    2017-01-01

    To know the ways and means of comfort perceived by the older adults hospitalized in a medical service. Ethnographic study with a qualitative approach. We conducted semi-structured interviews with 22 older adults and participant observation of care situations. The ways and means of providing comfort are centered on strategies for promoting care mobilized by nurses and recognized by patients(clarifying/informing, positive interaction/communication, music therapy, touch, smile, unconditional presence, empathy/proximity relationship, integrating the older adult or the family as partner in the care, relief of discomfort through massage/mobilization/therapy) and on particular moments of comfort (the first contact, the moment of personal hygiene, and the visit of the family), which constitute the foundation of care/comfort. Geriatric care is built on the relationship that is established and complete with meaning, and is based on the meeting/interaction between the actors under the influence of the context in which they are inserted. The different ways and means of providing comfort aim to facilitate/increase care, relieve discomfort and/or invest in potential comfort. Conhecer os modos e formas de confortar percecionadas pelos idosos hospitalizados num serviço de medicina. Estudo etnográfico com abordagem qualitativa. Realizamos entrevistas semiestruturadas com 22 doentes idosos e observação participante nas situações de cuidados. Os modos e formas de confortar centram-se em estratégias promotoras de conforto mobilizadas pelo enfermeiro e reconhecidas pelos doentes (informação/esclarecimento, interação/comunicação positiva, toque, sorriso, presença incondicional, integração do idoso/família nos cuidados e o alívio de desconfortos através da massagem/mobilização/terapêutica) e em momentos particulares de conforto (contato inaugural, visita da família., cuidados de higiene e arranjo pessoal), que se constituem como alicerces do cuidar

  2. A need for otolaryngology education among primary care providers

    Science.gov (United States)

    Hu, Amanda; Sardesai, Maya G.; Meyer, Tanya K.

    2012-01-01

    Objective Otolaryngic disorders are very common in primary care, comprising 20–50% of presenting complaints to a primary care provider. There is limited otolaryngology training in undergraduate and postgraduate medical education for primary care. Continuing medical education may be the next opportunity to train our primary care providers (PCPs). The objective of this study was to assess the otolaryngology knowledge of a group of PCPs attending an otolaryngology update course. Methods PCPs enrolled in an otolaryngology update course completed a web-based anonymous survey on demographics and a pre-course knowledge test. This test was composed of 12 multiple choice questions with five options each. At the end of the course, they were asked to evaluate the usefulness of the course for their clinical practice. Results Thirty seven (74%) PCPs completed the survey. Mean knowledge test score out of a maximum score of 12 was 4.0±1.7 (33.3±14.0%). Sorted by area of specialty, the mean scores out of a maximum score of 12 were: family medicine 4.6±2.1 (38.3±17.3%), pediatric medicine 4.2±0.8 (35.0±7.0%), other (e.g., dentistry, emergency medicine) 4.2±2.0 (34.6±17.0%), and adult medicine 3.9±2.1 (32.3±17.5%). Ninety one percent of respondents would attend the course again. Conclusion There is a low level of otolaryngology knowledge among PCPs attending an otolaryngology update course. There is a need for otolaryngology education among PCPs. PMID:22754276

  3. Job Satisfaction and Affecting Factors in Primary Health Care Providers

    Directory of Open Access Journals (Sweden)

    Ferit Kaya

    2016-06-01

    Full Text Available Objective: The aim of this study is to assess the job sat­isfaction of the primary health care providers and the fac­tors affecting it. Methods: This cross-sectional and descriptive study was carried out among the staff in The Public Health Care Centers (PHCC by performing a questionnaire under di­rect observation. Results: Out of 310 people consisting of the study uni­verse, 282 participants (94% were reached. The par­ticipants were 104 doctors, 132 assistant health care providers and 46 others (janitors, drivers The mean age of the participants was 37.21±7.70; 60.6% of them were women, 80.1% married, 96.5% graduated from at least High school. The mean of the general job satisfac­tion point of the participants in the study is 63.24±13.63. While the mean of the general job satisfaction point of the physicians and the nurses is found higher, the mean of the general job satisfaction point of janitors and other staff was found lower. The mean of the general job sat­isfaction point was found higher among the permanent and contract employee, women, health care staff, those whose wife/husband works, who chose his job willingly, more educated; who has longer working hours, high in­come, has 3 or less children and finds his job suitable for his skills; however the marital status, having children and age do not affect the mean job satisfaction point. Conclusion: Subjects having high income, found his job suitable for his skills, chose his job willingly had higher job satisfaction scores. This implies that there should be a wage balance among the staff with the same status. The lower job satisfaction score in PHCC indicates the neces­sity of improving the conditions of these centers.

  4. Deficiencies in culturally competent asthma care for ethnic minority children: a qualitative assessment among care providers

    Directory of Open Access Journals (Sweden)

    Seeleman Conny

    2012-07-01

    Full Text Available Abstract Background Asthma outcomes are generally worse for ethnic minority children. Cultural competence training is an instrument for improving healthcare for ethnic minority patients. To develop effective training, we explored the mechanisms in paediatric asthma care for ethnic minority patients that lead to deficiencies in the care process. Methods We conducted semi-structured interviews on care for ethnic minority children with asthma (aged 4-10 years with paediatricians (n = 13 and nurses (n = 3 in three hospitals. Interviews were analysed qualitatively with a framework method, using a cultural competence model. Results Respondents mentioned patient non-adherence as the central problem in asthma care. They related non-adherence in children from ethnic minority backgrounds to social context factors, difficulties in understanding the chronic nature of asthma, and parents’ language barriers. Reactions reported by respondents to patients’ non-adherence included retrieving additional information, providing biomedical information, occasionally providing referrals for social context issues, and using informal interpreters. Conclusions This study provides keys to improve the quality of specialist paediatric asthma care to ethnic minority children, mainly related to non-adherence. Care providers do not consciously recognise all the mechanisms that lead to deficiencies in culturally competent asthma care they provide to ethnic minority children (e.g. communicating mainly from a biomedical perspective and using mostly informal interpreters. Therefore, the learning objectives of cultural competence training should reflect issues that care providers are aware of as well as issues they are unaware of.

  5. Health care providers' comfort with and barriers to care of transgender youth.

    Science.gov (United States)

    Vance, Stanley R; Halpern-Felsher, Bonnie L; Rosenthal, Stephen M

    2015-02-01

    To explore providers' clinical experiences, comfort, and confidence with and barriers to providing care to transgender youth. An online survey was administered to members of the Society for Adolescent Health and Medicine and the Pediatric Endocrine Society with items querying about clinical exposure to transgender youth, familiarity with and adherence to existing clinical practice guidelines, perceived barriers to providing transgender-related care, and comfort and confidence with providing transgender-related care. The response rate was 21.9% (n = 475). Of the respondents, 66.5% had provided care to transgender youth, 62.4% felt comfortable with providing transgender medical therapy, and 47.1% felt confident in doing so. Principal barriers to provision of transgender-related care were lack of the following: training, exposure to transgender patients, available qualified mental health providers, and insurance reimbursement. This study suggests that more training in transgender-related care, available qualified mental health providers, and insurance reimbursement for transgender-related care are needed. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  6. Providing surgical care in Somalia: A model of task shifting.

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    Chu, Kathryn M; Ford, Nathan P; Trelles, Miguel

    2011-07-15

    Somalia is one of the most political unstable countries in the world. Ongoing insecurity has forced an inconsistent medical response by the international community, with little data collection. This paper describes the "remote" model of surgical care by Medecins Sans Frontieres, in Guri-El, Somalia. The challenges of providing the necessary prerequisites for safe surgery are discussed as well as the successes and limitations of task shifting in this resource-limited context. In January 2006, MSF opened a project in Guri-El located between Mogadishu and Galcayo. The objectives were to reduce mortality due to complications of pregnancy and childbirth and from violent and non-violent trauma. At the start of the program, expatriate surgeons and anesthesiologists established safe surgical practices and performed surgical procedures. After January 2008, expatriates were evacuated due to insecurity and surgical care has been provided by local Somalian doctors and nurses with periodic supervisory visits from expatriate staff. Between October 2006 and December 2009, 2086 operations were performed on 1602 patients. The majority (1049, 65%) were male and the median age was 22 (interquartile range, 17-30). 1460 (70%) of interventions were emergent. Trauma accounted for 76% (1585) of all surgical pathology; gunshot wounds accounted for 89% (584) of violent injuries. Operative mortality (0.5% of all surgical interventions) was not higher when Somalian staff provided care compared to when expatriate surgeons and anesthesiologists. The delivery of surgical care in any conflict-settings is difficult, but in situations where international support is limited, the challenges are more extreme. In this model, task shifting, or the provision of services by less trained cadres, was utilized and peri-operative mortality remained low demonstrating that safe surgical practices can be accomplished even without the presence of fully trained surgeon and anesthesiologists. If security improves

  7. Evaluating a nurse-led model for providing neonatal care.

    Science.gov (United States)

    2004-07-01

    The paper presents an overview of a multi-dimensional, prospective, comparative 5-year audit of the quality of the neonatal care provided by a maternity unit in the UK delivering 2000 babies a year, where all neonatal care after 1995 was provided by advanced neonatal nurse practitioners, in relation to that provided by a range of other medically staffed comparator units. The audit includes 11 separate comparative studies supervised by a panel of independent external advisors. Data on intrapartum and neonatal mortality is reported. A review of resuscitation at birth, and a two-tier confidential inquiry into sentinel events in six units were carried out. The reliability of the routine predischarge neonatal examination was studied and, in particular, the recognition of congenital heart disease. A review of the quality of postdischarge letters was undertaken alongside an interview survey to elicit parental views on care provision. An audit of all hospital readmissions within 28 days of birth is reported. Other areas of study include management of staff stress, perceived adequacy of the training of nurse practitioners coming into post, and an assessment of unit costs. Intrapartum and neonatal death among women with a singleton pregnancy originally booked for delivery in Ashington fell 39% between 1991-1995 and 1996-2000 (5.12 vs. 3.11 deaths per 1000 births); the decline for the whole region was 27% (4.10 vs. 2.99). By all other indicators the quality of care in the nurse-managed unit was as good as, or better than, that in the medically staffed comparator units. An appropriately trained, stable team with a store of experience can deliver cot-side care of a higher quality than staff rostered to this task for a few months to gain experience, and this is probably more important than their medical or nursing background. Factors limiting the on-site availability of medical staff with paediatric expertise do not need to dictate the future disposition of maternity services.

  8. Manipulative therapy in addition to usual medical care accelerates recovery of shoulder complaints at higher costs: economic outcomes of a randomized trial

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    Bergman Gert JD

    2010-09-01

    Full Text Available Abstract Background Shoulder complaints are common in primary care and have unfavourable long term prognosis. Our objective was to evaluate the clinical effectiveness of manipulative therapy of the cervicothoracic spine and the adjacent ribs in addition to usual medical care (UMC by the general practitioner in the treatment of shoulder complaints. Methods This economic evaluation was conducted alongside a randomized trial in primary care. Included were 150 patients with shoulder complaints and a dysfunction of the cervicothoracic spine and adjacent ribs. Patients were treated with UMC (NSAID's, corticosteroid injection or referral to physical therapy and were allocated at random (yes/no to manipulative therapy (manipulation and mobilization. Patient perceived recovery, severity of main complaint, shoulder pain, disability and general health were outcome measures. Data about direct and indirect costs were collected by means of a cost diary. Results Manipulative therapy as add-on to UMC accelerated recovery on all outcome measures included. At 26 weeks after randomization, both groups reported similar recovery rates (41% vs. 38%, but the difference between groups in improvement of severity of the main complaint, shoulder pain and disability sustained. Compared to the UMC group the total costs were higher in the manipulative group (€1167 vs. €555. This is explained mainly by the costs of the manipulative therapy itself and the higher costs due sick leave from work. The cost effectiveness ratio showed that additional manipulative treatment is more costly but also more effective than UMC alone. The cost-effectiveness acceptability curve shows that a 50%-probability of recovery with AMT within 6 months after initiation of treatment is achieved at €2876. Conclusion Manipulative therapy in addition to UMC accelerates recovery and is more effective than UMC alone on the long term, but is associated with higher costs. International Standard

  9. Factors associated with job satisfaction by Chinese primary care providers.

    Science.gov (United States)

    Shi, Leiyu; Song, Kuimeng; Rane, Sarika; Sun, Xiaojie; Li, Hui; Meng, Qingyue

    2014-01-01

    This study provides a snapshot of the current state of primary care workforce (PCW) serving China's grassroots communities and examines the factors associated with their job satisfaction. Data for the study were from the 2011 China Primary Care Workforce Survey, a nationally representative survey that provides the most current assessment of community-based PCW. Outcome measures included 12 items on job satisfaction. Covariates included intrinsic and extrinsic factors associated with job satisfaction. In addition, PCW type (i.e., physicians, nurses, public health, and village doctors) and practice setting (i.e., rural versus urban) were included to identify potential differences due to the type of PCW and practice settings. The overall satisfaction level is rather low with only 47.6% of the Chinese PCW reporting either satisfied or very satisfied with their job. PCW are least satisfied with their income level (only 8.6% are either satisfied or very satisfied), benefits (12.8%), and professional development (19.5%). They (particularly village doctors) are also dissatisfied with their workload (37.2%). Lower income and higher workload are the two major contributing factors toward job dissatisfaction. To improve the general satisfaction level, policymakers must provide better pay and benefits and more opportunities for career development, particularly for village doctors.

  10. Knowledge and Preferences of Primary Care Providers in Delivering Head and Neck Cancer Survivorship Care.

    Science.gov (United States)

    Berkowitz, Callie; Allen, Deborah H; Tenhover, Jennifer; Zullig, Leah L; Ragsdale, John; Fischer, Jonathan E; Pollak, Kathryn I; Koontz, Bridget F

    2017-07-14

    Long-term care for head and neck cancer (HNC) survivors is complex and requires coordination among multiple providers. Clinical practice guidelines highlight the role of primary care providers (PCPs) in screening for secondary cancer/recurrence, assessment of late/long-term side effects, and referrals for appropriate specialty management of toxicity. However, these responsibilities may be difficult to meet within the scope of primary care practice. We conducted this study to explore preferences, comfort, and knowledge of PCPs in the care of HNC survivors. We piloted a 40-item web-based survey developed with oncologist and PCP input targeted for family medicine and internal medicine providers. Responses were collected within a single university health system over 2 months. PCPs (n = 28; RR = 11.3%) were interested in learning about health promotion after cancer treatment (89%) and generally agree that their current practice patterns address healthy lifestyle behaviors (82%). However, only 32% of PCPs felt confident they could manage late/long-term side effects of chemotherapy, radiation, or surgery. Only 29% felt confident they could provide appropriate cancer screening. Looking at shared care responsibilities with oncology providers, PCPs perceived being responsible for 30% of care in the first year after treatment and 81% of care after 5 years. Seventy-one percent of PCPs agreed that oncologists provided them necessary information, yet 32% of PCPs found it difficult to coordinate with cancer providers. While these PCPs perceive increased care responsibility for long-term survivors, most are uncomfortable screening for recurrence and managing late/long-term side effects. Education and mutual coordination between PCPs and oncology providers may improve survivor care.

  11. Revascularization and cardioprotective drug treatment in myocardial infarction patients: how do they impact on patients' survival when delivered as usual care

    Directory of Open Access Journals (Sweden)

    Courteau Josiane

    2006-05-01

    Full Text Available Abstract Background Randomized clinical trials showed the benefit of pharmacological and revascularization treatments in secondary prevention of myocardial infarction (MI, in selected population with highly controlled interventions. The objective of this study is to measure these treatments' impact on the cardiovascular (CV mortality rate among patients receiving usual care in the province of Quebec. Methods The study population consisted of a "naturalistic" cohort of all patients ≥ 65 years old living in the Quebec province, who survived a MI (ICD-9: 410 in 1998. The studied dependant variable was time to death from a CV disease. Independent variables were revascularization procedure and cardioprotective drugs. Death from a non CV disease was also studied for comparison. Revascularization procedure was defined as percutaneous transluminal coronary angioplasty (PTCA or coronary artery bypass graft (CABG. The exposure to cardioprotective drugs was defined as the number of cardioprotective drug classes (Acetylsalicylic Acid (ASA, Beta-Blockers, Angiotensin-Converting Enzyme (ACE Inhibitors, Statins claimed within the index period (first 30 days after the index hospitalization. Age, gender and a comorbidity index were used as covariates. Kaplan-Meier survival curves, Cox proportional hazard models, logistic regressions and regression trees were used. Results The study population totaled 5596 patients (3206 men; 2390 women. We observed 1128 deaths (20% within two years following index hospitalization, of them 603 from CV disease. The CV survival rate at two years is much greater for patients with revascularization, regardless of pharmacological treatments. For patients without revascularization, the CV survival rate increases with the number of cardioprotective drug classes claimed. Finally, Cox proportional hazard models, regression tree and logistic regression analyses all revealed that the absence of revascularization and, to a lower extent

  12. Generic substitution of antiretrovirals: patients' and health care providers' opinions.

    Science.gov (United States)

    Kieran, Jennifer A; O'Reilly, Eimear; O'Dea, Siobhan; Bergin, Colm; O'Leary, Aisling

    2017-10-01

    There is interest in introducing generic antiretroviral drugs (ARVs) into high-income countries in order to maximise efficiency in health care budgets. Studies examining patients' and providers' knowledge and attitudes to generic substitution in HIV are few. This was a cross-sectional, observational study with a convenience sample of adult HIV-infected patients and health care providers (HCPs). Data on demographics, knowledge of generic medicine and facilitators of generic substitution were collected. Descriptive and univariate analysis was performed using SPSS V.23™. Questionnaires were completed by 66 patients. Seventy-one per cent would have no concerns with the introduction of generic ARVs. An increase in frequency of administration (61%) or pill burden (53%) would make patients less likely to accept generic ARVs. There were 30 respondents to the HCP survey. Concerns included the supply chain of generics, loss of fixed dose combinations, adherence and use of older medications. An increase in dosing frequency (76%) or an increase in pill burden (50%) would make HCPs less likely to prescribe a generic ARV. The main perceived advantage was financial. Generic substitution of ARVs would be acceptable to the majority of patients and HCPs. Reinvesting savings back into HIV services would facilitate the success of such a programme.

  13. To provide care and be cared for in a multiple-bed hospital room.

    Science.gov (United States)

    Persson, Eva; Määttä, Sylvia

    2012-12-01

    To illuminate patients' experiences of being cared for and nurses' experiences of caring for patients in a multiple-bed hospital room. Many patients and healthcare personnel seem to prefer single-bed hospital rooms. However, certain advantages of multiple-bed hospital rooms (MBRs) have also been described. Eight men and eight women being cared for in a multiple-bedroom were interviewed, and two focus-group interviews (FGI) with 12 nurses were performed. A qualitative content analysis was used. One theme--Creating a sphere of privacy--and three categories were identified based on the patient interviews. The categories were: Being considerate, Having company and The patients' area. In the FGI, one theme--Integrating individual care with care for all--and two categories emerged: Experiencing a friendly atmosphere and Providing exigent care. Both patients and nurses described the advantages and disadvantages of multiple-bed rooms. The patient culture of taking care of one another and enjoying the company of room-mates were considered positive and gave a sense of security of both patients and nurses. The advantages were slight and could easily become disadvantages if, for example, room-mates were very ill or confused. The patients tried to maintain their privacy and dignity and claimed that there were small problems with room-mates listening to conversations. In contrast, the nurses stressed patient integrity as a main disadvantage and worked to protect the integrity of individual patients. Providing care for all patients simultaneously had the advantage of saving time. The insights gained in the present study could assist nurses in reducing the disadvantages and taking advantage of the positive elements of providing care in MBRs. Health professionals need to be aware of how attitudes towards male and female patients, respectively, could affect care provision. © 2012 The Authors. Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.

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

    Science.gov (United States)

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

    2018-05-15

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

  15. Moral distress experienced by health care professionals who provide home-based palliative care.

    Science.gov (United States)

    Brazil, Kevin; Kassalainen, Sharon; Ploeg, Jenny; Marshall, Denise

    2010-11-01

    Health care providers regularly encounter situations of moral conflict and distress in their practice. Moral distress may result in unfavorable outcomes for both health care providers and those in their care. The purpose of this study was to examine the experience of moral distress from a broad range of health care occupations that provide home-based palliative care as the initial step of addressing the issue. A critical incident approach was used in qualitative interviews to elicit the experiences on moral distress from 18 health care providers drawn from five home visiting organizations in south central Ontario, Canada. Most participants described at least two critical incidents in their interview generating a total of 47 critical incidents. Analyses of the critical incidents revealed 11 issues that triggered moral distress which clustered into three themes, (a) the role of informal caregivers, b) challenging clinical situations and (c) service delivery issues. The findings suggest that the training and practice environments for health care providers need to be designed to recognize the moral challenges related to day-to-day practice. Copyright © 2010 Elsevier Ltd. All rights reserved.

  16. Modelling catchment areas for secondary care providers: a case study.

    Science.gov (United States)

    Jones, Simon; Wardlaw, Jessica; Crouch, Susan; Carolan, Michelle

    2011-09-01

    Hospitals need to understand patient flows in an increasingly competitive health economy. New initiatives like Patient Choice and the Darzi Review further increase this demand. Essential to understanding patient flows are demographic and geographic profiles of health care service providers, known as 'catchment areas' and 'catchment populations'. This information helps Primary Care Trusts (PCTs) to review how their populations are accessing services, measure inequalities and commission services; likewise it assists Secondary Care Providers (SCPs) to measure and assess potential gains in market share, redesign services, evaluate admission thresholds and plan financial budgets. Unlike PCTs, SCPs do not operate within fixed geographic boundaries. Traditionally, SCPs have used administrative boundaries or arbitrary drive times to model catchment areas. Neither approach satisfactorily represents current patient flows. Furthermore, these techniques are time-consuming and can be challenging for healthcare managers to exploit. This paper presents three different approaches to define catchment areas, each more detailed than the previous method. The first approach 'First Past the Post' defines catchment areas by allocating a dominant SCP to each Census Output Area (OA). The SCP with the highest proportion of activity within each OA is considered the dominant SCP. The second approach 'Proportional Flow' allocates activity proportionally to each OA. This approach allows for cross-boundary flows to be captured in a catchment area. The third and final approach uses a gravity model to define a catchment area, which incorporates drive or travel time into the analysis. Comparing approaches helps healthcare providers to understand whether using more traditional and simplistic approaches to define catchment areas and populations achieves the same or similar results as complex mathematical modelling. This paper has demonstrated, using a case study of Manchester, that when estimating

  17. Patients' and Health Care Providers' Perception of Stressors in the Intensive Care Units.

    Science.gov (United States)

    Abuatiq, Alham

    2015-01-01

    The purposes of this study is first, to investigate intensive care patients' perceptions of stressors; second, to investigate the health care provider's perception of what constitutes a stressor from the patient's perspective; and third, to describe how health care providers manage their patients' stressors. This was a mixed-methods study; the quantitative section replicated Cornock's 1998 study of stress in the intensive care unit (ICU), with difference in sampling to include all health care providers in the ICU, in addition to nurses. The qualitative section added information to the current literature by describing how health care providers manage their patient's stressors. This article reports the quantitative findings of this study, as the qualitative section is presented in a separate article. It is important to describe ICU patients' stressful experiences to assess patient's stressors, provide holistic care to eliminate stressors, and provide feedback to health care providers. There is a need to describe the clinical practice related to stress perception and management of stressors in the critical care environment. A mixed-methods comparative descriptive design was used for the quantitative section, and a phenomenological approach guided the qualitative section. Lazarus and Folkman's theory formed the bases for integrating all variables investigated in this study. The sample included 70 ICU patients and 70 ICU health care providers. After consenting to participate in this study, subjects were given a demographic form and a paper-based tool, the Environmental Stressors graphic data form Questionnaire. Questionnaires were filled out by subjects anonymously in the ICU and returned to the researcher in the same setting. Descriptive statistics were analyzed using SPSS data analysis software. The top 3 most stressful items ranked by the patients included "being in pain," followed by "not being able to sleep" and "financial worries"; on the other hand, health care

  18. Efficacy and cost-effectiveness of a specialist depression service versus usual specialist mental health care to manage persistent depression: a randomised controlled trial.

    Science.gov (United States)

    Morriss, Richard; Garland, Anne; Nixon, Neil; Guo, Boliang; James, Marilyn; Kaylor-Hughes, Catherine; Moore, Richard; Ramana, Rajini; Sampson, Christopher; Sweeney, Timothy; Dalgleish, Tim

    2016-09-01

    Persistent moderate or severe unipolar depression is common and expensive to treat. Clinical guidelines recommend combined pharmacotherapy and psychotherapy. Such treatments can take up to 1 year to show an effect, but no trials of suitable duration have been done. We investigated the efficacy and cost-effectiveness of outpatient-based, specialist depression services (SDS) versus treatment as usual (TAU) on depression symptoms and function. We did a multicentre, single-blind, patient-level, parallel, randomised controlled trial (RCT), as part of the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) study, in three mental health outpatient settings in England. Eligible participants were in secondary care, were older than 18 years, had unipolar depression (with a current major depressive episode, a 17-item Hamilton Depression Rating Scale [HDRS17] score of ≥16, and a Global Assessment of Function [GAF] score of ≤60), and had not responded to 6 months or more of treatment for depression. Randomisation was stratified by site with allocation conveyed to a trial administrator, with research assessors masked to outcome. Patients were randomised (1:1) using a computer-generated pseudo-random code with random permuted blocks of varying sizes of two, four, or six to either SDS (collaborative care approach between psychiatrists and cognitive behavioural therapists for 12 months, followed by graduated transfer of care up to 15 months) or to the TAU group. Intention-to-treat primary outcome measures were changes in HDRS17 and GAF scores between baseline and 6, 12, and 18 months' follow-up. We will separately publish follow-up outcomes for months 24 and 36. Clinical efficacy and cost-effectiveness were examined from health and social care persp ectives at 18 months, as recommended by the National Institute for Health and Care Excellence. This trial is registered at ClinicalTrials.gov (NCT01047124) and the

  19. A randomized, clinical trial of education or motivational-interviewing-based coaching compared to usual care to improve cancer pain management.

    Science.gov (United States)

    Thomas, Mary Laudon; Elliott, Janette E; Rao, Stephen M; Fahey, Kathleen F; Paul, Steven M; Miaskowski, Christine

    2012-01-01

    To test the effectiveness of two interventions compared to usual care in decreasing attitudinal barriers to cancer pain management, decreasing pain intensity, and improving functional status and quality of life (QOL). Randomized clinical trial. Six outpatient oncology clinics (three Veterans Affairs [VA] facilities, one county hospital, and one community-based practice in California, and one VA clinic in New Jersey)Sample: 318 adults with various types of cancer-related pain. Patients were randomly assigned to one of three groups: control, standardized education, or coaching. Patients in the education and coaching groups viewed a video and received a pamphlet on managing cancer pain. In addition, patients in the coaching group participated in four telephone sessions with an advanced practice nurse interventionist using motivational interviewing techniques to decrease attitudinal barriers to cancer pain management. Questionnaires were completed at baseline and six weeks after the final telephone calls. Analysis of covariance was used to evaluate for differences in study outcomes among the three groups. Pain intensity, pain relief, pain interference, attitudinal barriers, functional status, and QOL. Attitudinal barrier scores did not change over time among groups. Patients randomized to the coaching group reported significant improvement in their ratings of pain-related interference with function, as well as general health, vitality, and mental health. Although additional evaluation is needed, coaching may be a useful strategy to help patients decrease attitudinal barriers toward cancer pain management and to better manage their cancer pain. By using motivational interviewing techniques, advanced practice oncology nurses can help patients develop an appropriate plan of care to decrease pain and other symptoms.

  20. Effectiveness of telephone-based aftercare case management for adult patients with unipolar depression compared to usual care: A randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Laura Kivelitz

    Full Text Available Patients with depression often have limited access to outpatient psychotherapy following inpatient treatment. The objective of the study was to evaluate the long-term effectiveness of a telephone-based aftercare case management (ACM intervention for patients with depression.We performed a prospective randomized controlled trial in four psychotherapeutic inpatient care units with N = 199 patients with major depression or dysthymia (F32.x, F33.x, F34.1, according to the ICD-10. The ACM consisted of six phone contacts at two-week intervals performed by trained and certified psychotherapists. The control group received usual care (UC. The primary outcome was depressive symptom severity (BDI-II at 9-month follow-up, and secondary outcomes were health-related quality of life (SF-8, EQ-5D, self-efficacy (SWE, and the proportion of patients initiating outpatient psychotherapy. Mixed model analyses were conducted to compare improvements between treatment groups.Regarding the primary outcome of symptom severity, the groups did not significantly differ after 3 months (p = .132; ES = -0.23 or at the 9-month follow-up (p = .284; ES = -0.20. No significant differences in health-related quality of life or self-efficacy were found between groups. Patients receiving ACM were more likely to be in outpatient psychotherapy after 3 months (OR: 3.00[1.12-8.07]; p = .029 and 9 months (OR: 4.78 [1.55-14.74]; p = .006 than those receiving UC.Although telephone-based ACM did not significantly improve symptom severity, it seems to be a valuable approach for overcoming treatment barriers to the clinical pathways of patients with depression regarding their access to outpatient psychotherapy.

  1. An economic evaluation of the ketogenic diet versus care as usual in children and adolescents with intractable epilepsy: An interim analysis.

    Science.gov (United States)

    de Kinderen, Reina J A; Lambrechts, Danielle A J E; Wijnen, Ben F M; Postulart, Debby; Aldenkamp, Albert P; Majoie, Marian H J M; Evers, Silvia M A A

    2016-01-01

    To gain insight into the cost-effectiveness of the ketogenic (KD) diet compared with care as usual (CAU) in children and adolescents with intractable epilepsy, we conducted an economic evaluation from a societal perspective, alongside a randomized controlled trial. Participants from a tertiary epilepsy center were randomized into KD (intervention) group or CAU (control) group. Seizure frequency, quality adjusted life years (QALYs), health care costs, production losses of parents and patient, and family costs were assessed at baseline and during a 4-month study period and compared between the intervention and control groups. The incremental cost-effectiveness ratios (ICERs) (i.e., cost per QALY and cost per responder), and cost-effectiveness acceptability curves (CEACs) were calculated and presented. In total, 48 children were included in the analyses of this study (26 KD group). At 4 months, 50% of the participants in the KD group had a seizure reduction ≥50% from baseline, compared with 18.2 of the participants in the CAU group. The mean costs per patient in the CAU group were €15,245 compared to €20,986 per patient in the KD group, resulting in an ICER of €18,044 per responder. We failed, however, to measure any benefits in terms of QALYs and therefore, the cost per QALY rise high above any acceptable ceiling ratio. It might be that the quality of life instruments used in this study were not sufficiently sensitive to detect changes, or it might be that being a clinical responder is not sufficient to improve a patient's quality of life. Univariate and multivariate sensitivity analyses and nonparametric bootstrapping were performed and demonstrated the robustness of our results. The results show that the KD reduces seizure frequency. The study did not find any improvements in quality of life and, therefore, unfavorable cost per QALY ratio's resulted. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

  2. Dialectical Behavior Therapy Compared With Enhanced Usual Care for Adolescents With Repeated Suicidal and Self-Harming Behavior: Outcomes Over a One-Year Follow-Up.

    Science.gov (United States)

    Mehlum, Lars; Ramberg, Maria; Tørmoen, Anita J; Haga, Egil; Diep, Lien M; Stanley, Barbara H; Miller, Alec L; Sund, Anne M; Grøholt, Berit

    2016-04-01

    We conducted a 1-year prospective follow-up study of posttreatment clinical outcomes in adolescents with recent and repetitive self-harm who had been randomly allocated to receive 19 weeks of either dialectical behavior therapy adapted for adolescents (DBT-A) or enhanced usual care (EUC) at community child and adolescent psychiatric outpatient clinics. Assessments of self-harm, suicidal ideation, depression, hopelessness, borderline symptoms, and global level of functioning were made at the end of the 19-week treatment period and at follow-up 1 year later. Altogether 75 of the 77 (97%) adolescents participated at both time points. Frequencies of hospitalizations, emergency department visits and other use of mental health care during the 1-year follow-up period were recorded. Change analyses were performed using mixed effects linear spline regression and mixed effect Poisson regression with robust variance. Over the 52-week follow-up period, DBT-A remained superior to EUC in reducing the frequency of self-harm. For other outcomes such as suicidal ideation, hopelessness, and depressive or borderline symptoms and for the global level of functioning, inter-group differences apparent at the 19-week assessment were no longer observed, mainly due to participants in the EUC group having significantly improved on these dimensions over the follow-up year, whereas DBT-A participants remained unchanged. A stronger long-term reduction in self-harm and a more rapid recovery in suicidal ideation, depression, and borderline symptoms suggest that DBT-A may be a favorable treatment alternative for adolescents with repetitive self-harming behavior. Treatment for Adolescents With Deliberate Self Harm; http://clinicaltrials.gov/; NCT00675129. Copyright © 2016 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

  3. Time to standardise levels of care amongst Out-of-Hospital Emergency Care providers in Africa

    OpenAIRE

    Mould-Millman, N.K.; Stein, C.; Wallis, L.A.

    2016-01-01

    The African Federation for Emergency Medicine’s Out-of-Hospital Emergency Care (OHEC) Committee convened 15 experts from various OHEC systems in Africa to participate in a consensus process to define levels of care within which providers in African OHEC systems should safely and effectively function. The expert panel concluded that four provider levels were relevant for African OHEC systems: (i) first aid, (ii) basic life support, (iii) intermediate life support, and (iv) advanced life suppor...

  4. Clearing the airway by an emergency care provider in the prehospital emergency care

    OpenAIRE

    NOVOTNÁ, Magdalena

    2008-01-01

    Clearing an obstructed airway to facilitate breathing is a critical element of airway management. It is the emergency care provider who administers first aid and he/she has to master the technique of opening the airway as well as the aspiration prevention. The right airway management may avert the life-threatening condition of an injured person. The thesis is focused on the possibilities of clearing the airway by the emergency care provider in the Central Bohemian region. Techniques of openin...

  5. Exploring the Role of Farm Animals in Providing Care at Care Farms

    Science.gov (United States)

    Hassink, Jan; De Bruin, Simone R.; Berget, Bente; Elings, Marjolein

    2017-01-01

    Simple Summary This paper provides insight into the role of farm animals in farm-based programs and their importance to different types of participants. Farm animals provide real work, close relationships, challenging tasks and opportunities for reflection. They also contribute to a welcoming atmosphere for various types of participants. Abstract We explore the role of farm animals in providing care to different types of participants at care farms (e.g., youngsters with behavioural problems, people with severe mental problems and people with dementia). Care farms provide alternative and promising settings where people can interact with animals compared to a therapeutic healthcare setting. We performed a literature review, conducted focus group meetings and carried out secondary data-analysis of qualitative studies involving care farmers and different types of participants. We found that farm animals are important to many participants and have a large number of potential benefits. They can (i) provide meaningful day occupation; (ii) generate valued relationships; (iii) help people master tasks; (iv) provide opportunities for reciprocity; (v) can distract people from them problems; (vi) provide relaxation; (vii) facilitate customized care; (viii) facilitate relationships with other people; (ix) stimulate healthy behavior; (x) contribute to a welcoming environment; (xi) make it possible to experience basic elements of life; and (xii) provide opportunities for reflection and feedback. This shows the multi-facetted importance of interacting with animals on care farms. In this study the types of activities with animals and their value to different types of participants varied. Farm animals are an important element of the care farm environment that can address the care needs of different types of participants. PMID:28574435

  6. Effects of task-specific and impairment-based training compared with usual care on functional walking ability after inpatient stroke rehabilitation: LEAPS Trial.

    Science.gov (United States)

    Nadeau, Stephen E; Wu, Samuel S; Dobkin, Bruce H; Azen, Stanley P; Rose, Dorian K; Tilson, Julie K; Cen, Steven Y; Duncan, Pamela W

    2013-05-01

    After inpatient stroke rehabilitation, many people still cannot participate in community activities because of limited walking ability. To compare the effectiveness of 2 conceptually different, early physical therapy (PT) interventions to usual care (UC) in improving walking 6 months after stroke. The locomotor experience applied post-stroke (LEAPS) study was a single-blind, randomized controlled trial conducted in 408 adults with disabling hemiparetic stroke. Participants were stratified at baseline (2 months) by impairment in walking speed: severe (exercise at home (home exercise program [HEP], n = 126). LTP participants were 18% more likely to transition to a higher functional walking level: severe to >0.4 m/s and moderate to >0.8 m/s than UC participants (95% confidence interval [CI] = 7%-29%), and HEP participants were 17% more likely to transition (95% CI = 5%-29%). Mean gain in walking speed in LTP participants was 0.13 m/s greater (95% CI = 0.09-0.18) and in HEP participants, 0.10 m/s greater (95% CI = 0.05-0.14) than in UC participants. Progressive PT, using either walking training on a treadmill and overground, conducted in a clinic, or strength and balance exercises conducted at home, was superior to UC in improving walking, regardless of severity of initial impairment.

  7. The HAQ compared with the MDHAQ: "keep it simple, stupid" (KISS), with feasibility and clinical value as primary criteria for patient questionnaires in usual clinical care.

    Science.gov (United States)

    Pincus, Theodore; Swearingen, Christopher J

    2009-11-01

    The health assessment questionnaire (HAQ) is the questionnaire most widely used to assess and monitor patients with rheumatic diseases. The HAQ includes 20 activities grouped into 8 categories of 2 or 3 (and queries the use of "aids and devices" and "help from another person" to perform these activities), and visual analog scales (VAS) for pain and patient global estimate of status. Use of the HAQ in usual care over the years has led to several modifications to develop a multidimensional HAQ (MDHAQ). The MDHAQ includes 10 activities, one from each category of the HAQ plus 2 complex activities-walk 2 miles or 3 km-all on one side of a page for easy "eyeball" review by a clinician; pain, global and fatigue VAS with 21 circles rather than 10-cm lines for ease of scoring; recent medical history; review of systems; a query about exercise; and scoring templates for the 3 rheumatoid arthritis (RA) Core Data Set patient-reported measures-physical function, pain, and global estimate-for a routine assessment of patient index data (RAPID3) composite score. Both the HAQ and MDHAQ involve 2 sides of one sheet of paper, and are completed by patients in 5 to 10 minutes. The HAQ requires 42 seconds to score, compared with 5 to 10 seconds for RAPID3 on the MDHAQ.

  8. Efficacy of a modern neuroscience approach versus usual care evidence-based physiotherapy on pain, disability and brain characteristics in chronic spinal pain patients: protocol of a randomized clinical trial

    Science.gov (United States)

    2014-01-01

    Background Among the multiple conservative modalities, physiotherapy is a commonly utilized treatment modality in managing chronic non-specific spinal pain. Despite the scientific progresses with regard to pain and motor control neuroscience, treatment of chronic spinal pain (CSP) often tends to stick to a peripheral biomechanical model, without targeting brain mechanisms. With a view to enhance clinical efficacy of existing physiotherapeutic treatments for CSP, the development of clinical strategies targeted at ‘training the brain’ is to be pursued. Promising proof-of-principle results have been reported for the effectiveness of a modern neuroscience approach to CSP when compared to usual care, but confirmation is required in a larger, multi-center trial with appropriate evidence-based control intervention and long-term follow-up. The aim of this study is to assess the effectiveness of a modern neuroscience approach, compared to usual care evidence-based physiotherapy, for reducing pain and improving functioning in patients with CSP. A secondary objective entails examining the effectiveness of the modern neuroscience approach versus usual care physiotherapy for normalizing brain gray matter in patients with CSP. Methods/Design The study is a multi-center, triple-blind, two-arm (1:1) randomized clinical trial with 1-year follow-up. 120 CSP patients will be randomly allocated to either the experimental (receiving pain neuroscience education followed by cognition-targeted motor control training) or the control group (receiving usual care physiotherapy), each comprising of 3 months treatment. The main outcome measures are pain (including symptoms and indices of central sensitization) and self-reported disability. Secondary outcome measures include brain gray matter structure, motor control, muscle properties, and psychosocial correlates. Clinical assessment and brain imaging will be performed at baseline, post-treatment and at 1-year follow-up. Web

  9. Prescribing Outdoor Physical Activity to Children: Health Care Providers' Perspectives.

    Science.gov (United States)

    Christiana, Richard W; James, J Joy; Battista, Rebecca A

    2017-01-01

    Little evidence exists on health care provider (HCP) prescriptions for children's outdoor physical activity (PA). Semistructured interviews were conducted with 15 children's HCPs to explore perspectives on outdoor PA prescription programs for children and barriers to implementation. Thematic analytic techniques were used to analyze the data. Most participants reported an awareness of health benefits to children being in the outdoors. Ten themes emerged from the data related to 3 thematic categories: (1) current strategies that HCPs are using to promote PA among children, (2) barriers that HCPs see to prescribing outdoor PA, and (3) potential strategies for promoting outdoor PA among children. Assessment of the local outdoor PA environment and resource development must be done prior to a prescription program. HCPs should be skilled in conducting conversations and setting goals related to outdoor PA tailored to the patient. Developing a system for follow-up with patients on established goals should also be included.

  10. Family caregivers' health in connection with providing care.

    Science.gov (United States)

    Erlingsson, Christen L; Magnusson, Lennart; Hanson, Elizabeth

    2012-05-01

    Our aim was to investigate connections between Swedish family caregivers' health and providing care for an ill relative by conducting a systematic search and synthesis of previous research. We analyzed 31 articles using first qualitative content analysis then hermeneutic analysis. Analysis resulted in three derived themes-sliding sideways into caregiving, caregiving in reciprocity, and caregiving in disintegration-and a main interpretation and conceptual model of Swedish family caregivers' health-caregiving in a sphere of beliefs. Results indicated that Swedish family caregivers' beliefs, experiences of reciprocity, or nonsupport, together with quality of interpersonal relationships and feelings of responsibility and guilt, have a profound impact on their health. These results point to the value and importance of nurses gaining an understanding of family caregivers' beliefs and experiences of reciprocity or nonsupport to effectively promote family caregivers' health.

  11. Providing patient care in community pharmacies in Australia.

    Science.gov (United States)

    Benrimoj, Shalom I; Roberts, Alison S

    2005-11-01

    To describe Australia's community pharmacy network in the context of the health system and outline the provision of services. The 5000 community pharmacies form a key component of the healthcare system for Australians, for whom health expenditures represent 9% of the Gross Domestic Product. A typical community pharmacy dispenses 880 prescriptions per week. Pharmacists are key partners in the Government's National Medicines Policy and contribute to its objectives through the provision of cognitive pharmaceutical services (CPS). The Third Community Pharmacy Agreement included funding for CPS including medication review and the provision of written drug information. Funding is also provided for a quality assurance platform with which the majority of pharmacies are accredited. Fifteen million dollars (Australian) have been allocated to research in community pharmacy, which has focused on achieving quality use of medicines (QUM), as well as developing new CPS and facilitating change. Elements of the Agreements have taken into account QUM principles and are now significant drivers of practice change. Although accounting for 10% of remuneration for community pharmacy, the provision of CPS represents a significant shift in focus to view pharmacy as a service provider. Delivery of CPS through the community pharmacy network provides sustainability for primary health care due to improvement in quality presumably associated with a reduction in healthcare costs. Australian pharmacy practice is moving strongly in the direction of CPS provision; however, change does not occur easily. The development of a change management strategy is underway to improve the uptake of professional and business opportunities in community pharmacy.

  12. Documenting coordination of cancer care between primary care providers and oncology specialists in Canada.

    Science.gov (United States)

    Brouwers, Melissa C; Vukmirovic, Marija; Tomasone, Jennifer R; Grunfeld, Eva; Urquhart, Robin; O'Brien, Mary Ann; Walker, Melanie; Webster, Fiona; Fitch, Margaret

    2016-10-01

    To report on the findings of the CanIMPACT (Canadian Team to Improve Community-Based Cancer Care along the Continuum) Casebook project, which systematically documented Canadian initiatives (ie, programs and projects) designed to improve or support coordination and continuity of cancer care between primary care providers (PCPs) and oncology specialists. Pan-Canadian environmental scan. Canada. Individuals representing the various initiatives provided data for the analysis. Initiatives included in the Casebook met the following criteria: they supported coordination and collaboration between PCPs and oncology specialists; they were related to diagnosis, treatment, survivorship, or personalized medicine; and they included breast or colorectal cancer or both. Data were collected on forms that were compiled into summaries (ie, profiles) for each initiative. Casebook initiatives were organized based on the targeted stage of the cancer care continuum, jurisdiction, and strategy (ie, model of care or type of intervention) employed. Thematic analysis identified similarities and differences among employed strategies, the level of primary care engagement, implementation barriers and facilitators, and initiative evaluation. The CanIMPACT Casebook profiles 24 initiatives. Eleven initiatives targeted the survivorship stage of the cancer care continuum and 15 focused specifically on breast or colorectal cancer or both. Initiative teams implemented the following strategies: nurse patient navigation, multidisciplinary care teams, electronic communication or information systems, PCP education, and multicomponent initiatives. Initiatives engaged PCPs at various levels. Implementation barriers included lack of care standardization across jurisdictions and incompatibility among electronic communication systems. Implementation facilitators included having clinical and program leaders publicly support the initiative, repurposing existing resources, receiving financial support, and

  13. Health care providers' knowledge and practice of focused antenatal ...

    African Journals Online (AJOL)

    ... observational checklist were the instruments for data collection. Findings revealed poor knowledge of concept, components, timing of visits on focused antenatal care and non compliance with the guidelines for the practice of focused antenatal care, because of health workers lack of knowledge on focused antenatal care.

  14. End-of-life decisions in perinatal care. A view from health-care providers

    Directory of Open Access Journals (Sweden)

    Patricia Grether

    2015-11-01

    Full Text Available Objective. To examine the opinions of a perinatal health team regarding decisions related to late termination of pregnancy and severely ill newborns. Materials and Methods. An anonymous questionnaire was administered to physicians, social workers, and nurses in perinatal care. Differences were evaluated using the chi square and Student’s t tests. Results. When considering severely ill fetuses and newborns, 82% and 93% of participants, respectively, opted for providing palliative care, whereas 18% considered feticide as an alter- native. Those who opted for palliative care aimed to diminish suffering and those who opted for intensive care intended to protect life or sanctity of life. There was poor knowledge about the laws that regulate these decisions. Conclusions. Although there is no consensus on what decisions should be taken with severely ill fetuses or neonates, most participants considered palliative care as the first option, but feticide or induced neonatal death was not ruled out.

  15. Preliminary examination of metabolic syndrome response to motivational interviewing for weight loss as compared to an attentional control and usual care in primary care for individuals with and without binge-eating disorder.

    Science.gov (United States)

    Barnes, Rachel D; Barber, Jessica A

    2017-08-01

    Motivational interviewing (MI) treatment for weight loss is being studied in primary care. The effect of such interventions on metabolic syndrome or binge eating disorder (BED), both highly related to excess weight, has not been examined in primary care. This study conducted secondary analyses from a randomized controlled trial to test the impact of MI for weight loss in primary care on metabolic syndrome. 74 adult participants with overweight/obesity recruited through primary care were randomized to 12weeks of either MI, an attentional control, or usual care. Participants completed measurements for metabolic syndrome at pre- and post-treatment. There were no statistically significant differences in metabolic syndrome rates at pre-, X 2 (2)=0.16, p=0.921, or post-, X 2 (2)=0.852, p=0.653 treatment. The rates in metabolic syndrome, however, decreased for MI (10.2%) and attentional control (13.8%) participants, but not for usual care. At baseline, metabolic syndrome rates did not differ significantly between participants with BED or without BED across treatments. At post-treatment, participants with BED were significantly more likely to meet criteria for metabolic syndrome than participants without BED, X 2 (1)=5.145, p=0.023, phi=0.273. Across treatments, metabolic syndrome remitted for almost a quarter of participants without BED (23.1%) but for 0% of those with BED. These preliminary results are based on a small sample and should be interpreted with caution, but they are the first to suggest that relatively low intensity MI weight loss interventions in primary care may decrease metabolic syndrome rates but not for individuals with BED. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. Pregnant at work: time for prenatal care providers to act.

    Science.gov (United States)

    Karkowsky, Chavi Eve; Morris, Liz

    2016-09-01

    Fifty years ago, when a woman became pregnant, she was expected to stop working. Today, however, most women who work are the primary, sole, or co-breadwinner for their families, and their earnings during pregnancy are often essential to their families' economic well-being. Medical data about working during pregnancy are sparse but generally show that both low-risk and high-risk women can tolerate work-related duties well, although some work accommodations (eg, providing a chair for sitting, allowing snacks, or modifying the work schedule) may be necessary. However, some employers refuse to accommodate pregnant women who need adjustments. This can result in a woman being forced to make the choice between working without accommodations and losing her income and health insurance or even her job. Prenatal care providers can play an important role by implementing changes in their own practice, shaping public policy, and conducting research to increase protections for pregnant women and to ensure that they receive medically recommended accommodations while continuing to earn income for their growing families. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. [Providing regular relief; considerations for palliative care in the Netherlands].

    Science.gov (United States)

    Crul, B J; van Weel, C

    2001-10-20

    Over the last few decades the attention devoted to the palliative aspects of medicine, particularly those in hospital care, has declined due to the emphasis on medical technology. In Anglo-Saxon countries a review of this development resulted in structured palliative care that benefited terminally ill patients with a progressive fatal disease, especially cancer patients. Due to increasing national and international criticism of both the practice of euthanasia (assumed to be too liberal) and the lack of attention devoted to structured palliative care in the Netherlands, the Dutch government decided to improve the structure of palliative care. The government's viewpoint is based on the assumption that good palliative care that includes adequate pain control benefits patient care and might eventually lead to fewer requests for euthanasia. The improvements to palliative care should be realised by means of improvements in the structure, training and knowledge. Six academic medical clusters have been designated as Centres for the Development of Palliative Care (Dutch acronym: COPZ) for a 5-year period. Each COPZ must develop the various aspects needed to improve palliative care within the region it serves and ensure that its activities are carefully coordinated with those in the other centres. Research will focus on measuring the efficacy of palliative care as well as ethical and epidemiological aspects. A government committee will assess the appropriateness of the activities undertaken by each of the centres.

  18. Providing Cardiology Care in Rural Areas Through Visiting Consultant Clinics.

    Science.gov (United States)

    Gruca, Thomas S; Pyo, Tae-Hyung; Nelson, Gregory C

    2016-06-30

    Workforce experts predict a future shortage of cardiologists that is expected to impact rural areas more severely than urban areas. However, there is little research on how rural patients are currently served through clinical outreach. This study examines the impact of cardiology outreach in Iowa, a state with a large rural population, on participating cardiologists and on patient access. Outreach clinics are tracked annually in the Office of Statewide Clinical Education Programs Visiting Medical Consultant Database (University of Iowa Carver College of Medicine). Data from 2014 were analyzed. In 2014, an estimated 5460 visiting consultant clinic days were provided in 96 predominantly rural cities by 167 cardiologists from Iowa and adjoining states. Forty-five percent of Iowa cardiologists participated in rural outreach. Visiting cardiologists from Iowa and adjoining states drive an estimated 45 000 miles per month. Because of monthly outreach clinics, the average driving time to the nearest cardiologist falls from 42.2±20.0 to 14.7±11.0 minutes for rural Iowans. Cardiology outreach improves geographic access to office-based cardiology care for more than 1 million Iowans out of a total population of 3 million. Direct travel costs and opportunity costs associated with physician travel are estimated to be more than $2.1 million per year. Cardiologists in Iowa and adjoining states have expanded access to office-based cardiology care from 18 to 89 of the 99 counties in Iowa. In these 71 counties without a full-time cardiologist, visiting consultant clinics can accommodate more than 50% of office visits in the patients' home county. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  19. Out-of-hospital emergency care providers' work and challenges in a changing care environment.

    Science.gov (United States)

    Mikkola, Riitta; Paavilainen, Eija; Salminen-Tuomaala, Mari; Leikkola, Päivi

    2018-03-01

    Acutely ill patients are often treated on site instead of being transported to hospital, so wide-ranging professional competence is required from staff. The aim of this study was to describe and produce new information about out-of-hospital emergency care providers' competence, skills and willingness to engage in self-development activities, and to uncover challenges experienced by care providers in the midst of changing work practices. A quantitative questionnaire was sent to out-of-hospital emergency care providers (N = 142, response rate 53%) of one Finnish hospital district. Data were analysed using spss for Windows 22 software. Almost all respondents found their work interesting and their ability to work independently sufficient. The majority found the work meaningful. Almost 20% felt that work was dominated by constant rush, and 40%, more than half of 25-year-olds but <10% of over 45-years-olds, found the work physically straining. The majority indicated that they had a sufficient theoretical-practical basis to perform their regular duties, and more than one-third felt that they had sufficient skills to deal with multiple patient or disaster situations. Over 20% stated that they were unsure about performing new or infrequent procedures. A number of factors experienced as challenging were revealed. The results provide a basis for improving care providers' initial and further training. © 2017 Nordic College of Caring Science.

  20. Two-Year Stability and Change in Access to and Reasons for Lacking a Usual Source of Care Among Working-Age US Adults.

    Science.gov (United States)

    Stransky, Michelle L

    The objective of this study was to investigate usual source of care (USC) over time. A nationally representative sample of working-age adults in the Medical Expenditure Panel Survey (Panels 16 [2011-2012] and 17 [2012-2013]) was divided into 3 groups based on USC questions asked during 2 waves: (1) those having a USC during both waves (always USC), (2) those not having a USC during either wave (never USC), and (3) those who gained or lost a USC between the 2 waves (changed USC). The study examined the sociodemographic and health characteristics associated with these groups and the main reasons for not having a USC among those who never had a USC and those who changed their USC. Of the 10 792 adults in the analysis, a longitudinally weighted 18.8% reported that their USC changed during the period. Among adults in the changed USC group, those with private (odds ratio [OR] = 2.0, P = .001) or public (OR = 2.2, P = .001) health insurance and 1 (OR = 1.7, P = .04) or ≥2 (OR = 3.1, P = .02) chronic health conditions were more likely to transition to having a USC from not having a USC, compared with those who had no insurance and no chronic conditions. Compared with those in the changed USC group, those in the never USC group were more likely to report preferring not to have a USC (57.9% vs 80.1%, P USC and increase the number of adults with ongoing, consistent USC.

  1. Reports of "satisfactory relief" by IBS patients receiving usual medical care are confounded by baseline symptom severity and do not accurately reflect symptom improvement.

    Science.gov (United States)

    Whitehead, William E; Palsson, Olafur S; Levy, Rona L; Feld, Andrew D; VonKorff, Michael; Turner, Marsha

    2006-05-01

    Treatment trials for irritable bowel syndrome (IBS) usually define a responder as a patient who reports satisfactory relief or adequate relief of symptoms at the end of the trial. However, these measures have not been adequately validated. (1) Compare a binary satisfactory relief measure to alternative ways of defining a treatment responder. (2) Determine whether baseline IBS symptom severity or psychological distress influence the sensitivity of these outcome measures. A total of 350 patients (81% females, average age 50 yr) who had a medical diagnosis of IBS and satisfied Rome II criteria, were recruited from Group Health Cooperative of Puget Sound. At baseline the Irritable Bowel Severity Scale (IBSS) was used to assess symptom severity and to classify patients as mild, moderate, or severe. Psychological distress and IBS-specific quality of life (IBS-QOL) were also assessed. After 6 months treatment with standard medical care, IBSS and IBS-QOL were reassessed, and patients were asked whether they had experienced satisfactory relief and whether they were somewhat or markedly better. Initial severity of IBS significantly affected the proportion who reported satisfactory relief (mild, 72%; moderate, 53%; severe, 44%) and the proportion who were somewhat or markedly better (mild, 62%; moderate, 44%; severe, 38%), but did not affect the proportion with a 50% reduction in symptoms (mild, 26%; moderate, 25%; severe, 23%). Although mild patients were the most likely to report satisfactory relief, they showed no average decrease in symptom severity or improvement in IBS-QOL. Conversely, severe patients, who were the least likely to report satisfactory relief, had the largest reductions in IBS symptom severity and the largest improvements in IBS-QOL. Psychological distress had no significant effect on the responder rate after adjusting for IBS symptom severity. These data from a descriptive study suggest that satisfactory relief is confounded with initial IBS symptom

  2. Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care: study protocol for a randomised controlled trial (Prevquedas Brazil).

    Science.gov (United States)

    de Negreiros Cabral, Kelem; Perracini, Monica Rodrigues; Soares, Aline Thomaz; de Cristo Stein, Francine; Sera, Celisa Tiemi Nakagawa; Tiedemann, Anne; Sherrington, Cathie; Filho, Wilson Jacob; Paschoal, Sérgio Márcio Pacheco

    2013-03-15

    Falling in older age is a major public health concern due to its costly and disabling consequences. However very few randomised controlled trials (RCTs) have been conducted in developing countries, in which population ageing is expected to be particularly substantial in coming years. This article describes the design of an RCT to evaluate the effectiveness of a multifactorial falls prevention program in reducing the rate of falls in community-dwelling older people. Multicentre parallel-group RCT involving 612 community-dwelling men and women aged 60 years and over, who have fallen at least once in the previous year. Participants will be recruited in multiple settings in Sao Paulo, Brazil and will be randomly allocated to a control group or an intervention group. The usual care control group will undergo a fall risk factor assessment and be referred to their clinicians with the risk assessment report so that individual modifiable risk factors can be managed without any specific guidance. The intervention group will receive a 12-week Multifactorial Falls Prevention Program consisting of: an individualised medical management of modifiable risk factors, a group-based, supervised balance training exercise program plus an unsupervised home-based exercise program, an educational/behavioral intervention. Both groups will receive a leaflet containing general information about fall prevention strategies. Primary outcome measures will be the rate of falls and the proportion of fallers recorded by monthly falls diaries and telephone calls over a 12 month period. Secondary outcomes measures will include risk of falling, fall-related self-efficacy score, measures of balance, mobility and strength, fall-related health services use and independence with daily tasks. Data will be analysed using the intention-to-treat principle.The incidence of falls in the intervention and control groups will be calculated and compared using negative binomial regression analysis. This study is the

  3. Return-to-work intervention versus usual care for sick-listed employees: health-economic investment appraisal alongside a cluster randomised trial

    Science.gov (United States)

    Lokman, Suzanne; Volker, Danielle; Zijlstra-Vlasveld, Moniek C; Brouwers, Evelien PM; Boon, Brigitte; Beekman, Aartjan TF; Smit, Filip; Van der Feltz-Cornelis, Christina M

    2017-01-01

    Objective To evaluate the health-economic costs and benefits of a guided eHealth intervention (E-health module embedded in Collaborative Occupational healthcare (ECO)) encouraging sick-listed employees to a faster return to work. Design A two-armed cluster randomised trial with occupational physicians (OPs) (n=62), clustered and randomised by region into an experimental and a control group, to conduct a health-economic investment appraisal. Online self-reported data were collected from employees at baseline, after 3, 6, 9 and 12 months. Setting Occupational health care in the Netherlands. Participants Employees from small-sized and medium-sized companies (≥18 years), sick-listed between 4 and 26 weeks with (symptoms of) common mental disorders visiting their OP. Interventions In the intervention group, employees (N=131) received an eHealth module aimed at changing cognitions regarding return to work, while OPs were supported by a decision aid for treatment and referral options. Employees in the control condition (N=89) received usual sickness guidance. Outcomes Measures Net benefits and return on investment based on absenteeism, presenteeism, health care use and quality-adjusted life years (QALYs) gained. Results From the employer’s perspective, the incremental net benefits were €3187 per employee over a single year, representing a return of investment of €11 per invested Euro, with a break-even point at 6 months. The economic case was also favourable from the employee’s perspective, partly because of QALY health gains. The intervention was costing €234 per employee from a health service financier’s perspective. The incremental net benefits from a social perspective were €4210. This amount dropped to €3559 in the sensitivity analysis trimming the 5% highest costs. Conclusions The data suggest that the ECO intervention offers good value for money for virtually all stakeholders involved, because initial investments were more than recouped within a

  4. Comparative Effectiveness of Homoeopathic vs. Conventional Therapy in Usual Care of Atopic Eczema in Children: Long-Term Medical and Economic Outcomes

    Science.gov (United States)

    Roll, Stephanie; Reinhold, Thomas; Pach, Daniel; Brinkhaus, Benno; Icke, Katja; Staab, Doris; Jäckel, Tanja; Wegscheider, Karl; Willich, Stefan N.; Witt, Claudia M.

    2013-01-01

    Background One in five children visiting a homeopathic physician suffers from atopic eczema. Objectives We aimed to examine the long-term effectiveness, safety and costs of homoeopathic vs. conventional treatment in usual medical care of children with atopic eczema. Methods In this prospective multi-centre comparative observational non-randomized rater-blinded study, 135 children (48 homoeopathy, 87 conventional) with mild to moderate atopic eczema were included by their respective physicians. Depending on the specialisation of the physician, the primary treatment was either standard conventional treatment or individualized homeopathy as delivered in routine medical care. The main outcome was the SCORAD (SCORing Atopic Dermatitis) at 36 months by a blinded rater. Further outcomes included quality of life, conventional medicine consumption, safety and disease related costs at six, 12 and 36 months after baseline. A multilevel ANCOVA was used, with physician as random effect and the following fixed effects: age, gender, baseline value, severity score, social class and parents’ expectation. Results The adjusted mean SCORAD showed no significant differences between the groups at 36 months (13.7 95% CI [7.9–19.5] vs. 14.9 [10.4–19.4], p = 0.741). The SCORAD response rates at 36 months were similar in both groups (33% response: homoeopathic 63.9% vs. conventional 64.5%, p = 0.94; 50% response: 52.0% vs. 52.3%, p = 0.974). Total costs were higher in the homoeopathic versus the conventional group (months 31–36 200.54 Euro [132.33–268.76] vs. 68.86 Euro [9.13–128.58], p = 0.005). Conclusions Taking patient preferences into account, while being unable to rule out residual confounding, in this long-term observational study, the effects of homoeopathic treatment were not superior to conventional treatment for children with mild to moderate atopic eczema, but involved higher costs. PMID:23383019

  5. [Intercultural health care policy from the perspective of health care providers and Mapuche clients].

    Science.gov (United States)

    Alarcón, Ana María; Astudillo, Paula; Barrios, Sara; Rivas, Edith

    2004-09-01

    Intercultural health is becoming an emergent topic in the design of health care programs for Mapuche people of Chile. This process faces important challenges such as the scarce theoretical support about the meaning of intercultural health and their practical consequences for providers and clients. To explore the perception in providers and Mapuche clients about intercultural health. A survey performed in 11 counties with the highest concentration of Mapuche people, of the IX region of Chile. The perception about the development of a new health policy specially designed for Mapuche patients was surveyed in 399 Mapuche patients and 64 providers of primary health care centers. Mapuche clients considered, as the main regional challenges, the indifference and discrimination of health care teams towards Mapuche patients, aggravated by the indifference of authorities. Providers considered that the main problem was a lack of knowledge about Mapuche culture and skills to deal with this ethnic group. Patients and providers agreed on the need to use Mapuche dialect in health care attentions, to coordinate actions with traditional healers and to accept ethnical therapeutic practices. There is scarce agreement between providers and Mapuche clients about the need for an special intercultural health policy, its contents, and the regional conditions for its implementation and development.

  6. [Providing regular relief; considerations for palliative care in the Netherlands

    NARCIS (Netherlands)

    Crul, B.J.P.; Weel, C. van

    2001-01-01

    Over the last few decades the attention devoted to the palliative aspects of medicine, particularly those in hospital care, has declined due to the emphasis on medical technology. In Anglo-Saxon countries a review of this development resulted in structured palliative care that benefited terminally

  7. Paediatric palliative care providers' experiences in rural KwaZulu ...

    African Journals Online (AJOL)

    based palliative care (including paediatric palliative care) is available to patients in rural ... reported that one of the most distressing tasks a nurse has to carry out is telling any .... die, as a miracle (such as a cure) is presented as a possibility.

  8. [Case report: coordination of the care provided to patients with breast cancer].

    Science.gov (United States)

    Peinado-Barraso, M del Carmen; Cabrerizo-Cordero, M del Rosario; Granados-Matute, Ana Eva; Contreras-Fariñas, Raquel

    2008-01-01

    In Spain, cancer is the leading cause of death in absolute terms. Statistically, the most frequent type of cancer in women in developed countries is breast cancer, which is becoming the leading cause of death from cancer among women. The breast cancer is statistically the most frequent in women and it is getting the first reason of death by cancer between the feminine population, in most of developed countries. This health problem is usually associated with psychological dependency, which can be aggravated in elderly patients without adequate family support. TThe nursing process is the most commonly used tool to establish interaction among the nurse, the patient and the family. Through this interaction, the nurse can identify the patient's health objectives and energy limitations, as well as the resources available to obtain optimal health status. The nursing process is a systematic method for providing efficient humanistic care aimed at achieving expected outcomes. In the case presented herein, we employed Marjory Gordon's Functional Patterns and the taxonomies of the North American Nursing Diagnosis Association (NANDA), Nursing Interventions Classification (NIC) and Nursing Outcomes Classification (NOC). The nursing diagnoses detected were fear, anxiety, self-care deficit, impaired mobility, risk of low self-esteem, ineffective coping, and potential complications (pain and infection). The care session is one of the main interventions to improve the effectiveness of the care provided. During this session, methodological adjustments of the nursing process are analyzed, with special attention paid to the appropriateness of the interventions, the possible alternatives and encouragement of reflective practice Essential elements to improve quality of life in these elderly oncology patients are the role of nursing through the care provided and coordination among professionals in different disciplines and healthcare levels.

  9. Racial disparities in reported prenatal care advice from health care providers.

    Science.gov (United States)

    Kogan, M D; Kotelchuck, M; Alexander, G R; Johnson, W E

    1994-01-01

    OBJECTIVES. The relationship between certain maternal behaviors and adverse pregnancy outcomes has been well documented. One method to alter these behaviors is through the advice of women's health care providers. Advice from providers may be particularly important in minority populations, who have higher rates of infant mortality and prematurity. This study examines racial disparities according to women's self-report of advice received from health care providers during pregnancy in four areas: tobacco use, alcohol consumption, drug use, and breast-feeding. METHODS. Health care providers' advice to 8310 White non-Hispanic and Black women was obtained from the National Maternal and Infant Health Survey. RESULTS. After controlling for sociodemographic, utilization, and medical factors, Black women were more likely to report not receiving advice from their prenatal care providers about smoking cessation and alcohol use. The difference between Blacks and Whites also approached significance for breast-feeding. No overall difference was noted in advice regarding cessation of drug use, although there was a significant interaction between race and marital status. CONCLUSIONS. These data suggest that Black women may be at greater risk for not receiving information that could reduce their chances of having an adverse pregnancy outcome. PMID:8279618

  10. Derivative financial instruments and nonprofit health care providers.

    Science.gov (United States)

    Stewart, Louis J; Owhoso, Vincent

    2004-01-01

    This article examines the extent of derivative financial instrument use among US nonprofit health systems and the impact of these financial instruments on their cash flows, reported operating results, and financial risks. Our examination is conducted through a case study of New Jersey hospitals and health systems. We review the existing literature on interest rate derivative instruments and US hospitals and health systems. This literature describes the design of these derivative financial instruments and the theoretical benefits of their use by large health care provider organizations. Our contribution to the literature is to provide an empirical evaluation of derivative financial instruments usage among a geographically limited sample of US nonprofit health systems. We reviewed the audited financial statements of the 49 community hospitals and multi-hospital health systems operating in the state of New Jersey. We found that 8 percent of New Jersey's nonprofit health providers utilized interest rate derivatives with an aggregate principle value of $229 million. These derivative users combine interest rate swaps and caps to lower the effective interest costs of their long-term debt while limiting their exposure to future interest rate increases. In addition, while derivative assets and liabilities have an immaterial balance sheet impact, derivative related gains and losses are a material component of their reported operating results. We also found that derivative usage among these four health systems was responsible for generating positive cash flows in the range of 1 percent to 2 percent of their total 2001 cash flows from operations. As a result of our admittedly limited samples we conclude that interest rate swaps and caps are effective risk management tools. However, we also found that while these derivative financial instruments are useful hedges against the risks of issuing long-term financing instruments, they also expose derivative users to credit, contract

  11. Providing high-quality care in primary care settings: how to make trade-offs.

    Science.gov (United States)

    Beaulieu, Marie-Dominique; Geneau, Robert; Del Grande, Claudio; Denis, Jean-Louis; Hudon, Eveline; Haggerty, Jeannie L; Bonin, Lucie; Duplain, Réjean; Goudreau, Johanne; Hogg, William

    2014-05-01

    To gain a deeper understanding of how primary care (PC) practices belonging to different models manage resources to provide high-quality care. Multiple-case study embedded in a cross-sectional study of a random sample of 37 practices. Three regions of Quebec. Health care professionals and staff of 5 PC practices. Five cases showing above-average results on quality-of-care indicators were purposefully selected to contrast on region, practice size, and PC model. Data were collected using an organizational questionnaire; the Team Climate Inventory, which was completed by health care professionals and staff; and 33 individual interviews. Detailed case histories were written and thematic analysis was performed. The core common feature of these practices was their ongoing effort to make trade-offs to deliver services that met their vision of high-quality care. These compromises involved the same 3 areas, but to varying degrees depending on clinic characteristics: developing a shared vision of high-quality care; aligning resource use with that vision; and balancing professional aspirations and population needs. The leadership of the physician lead was crucial. The external environment was perceived as a source of pressure and dilemmas rather than as a source of support in these matters. Irrespective of their models, PC practices' pursuit of high-quality care is based on a vision in which accessibility is a key component, balanced by appropriate management of available resources and of external environment expectations. Current PC reforms often create tensions rather than support PC practices in their pursuit of high-quality care. Copyright© the College of Family Physicians of Canada.

  12. Screening for distress, the 6th vital sign: common problems in cancer outpatients over one year in usual care: associations with marital status, sex, and age

    Directory of Open Access Journals (Sweden)

    Giese-Davis Janine

    2012-10-01

    Full Text Available Abstract Background Very few studies examine the longitudinal prevalence of problems and the awareness or use of clinical programs by patients who report these problems. Of the studies that examine age, gender and marital status as predictors of a range of patient outcomes, none examines the interactions between these demographic variables. This study examined the typical trajectory of common practical and psychosocial problems endorsed over 12 months in a usual-care sample of cancer outpatients. Specifically, we examined whether marital status, sex, age, and their interactions predicted these trajectories. We did not actively triage or refer patients in this study in order to examine the natural course of problem reports. Methods Patients completed baseline screening (N = 1196 of 1707 approached and the sample included more men (N = 696 than women (N = 498, average age 61.1 years. The most common diagnoses were gastrointestinal (27.1%, prostate (19.2%, skin (11.1% and gynecological (9.2%. Among other measures, patients completed a Common Problem Checklist and Psychosocial Resources Use questions at baseline, 3, 6, and 12 months using paper and pencil surveys. Results Results indicated that patients reported psychosocial problems more often than practical and both decreased significantly over time. Younger single patients reported more practical problems than those in committed relationships. Younger patients and women of all ages reported more psychosocial problems. Among a number of interesting interactions, for practical problems, single older patients improved more; whereas among married people, younger patients improved more. For psychosocial problems we found that older female patients improved more than younger females, but among males, it was younger patients who improved more. Young single men and women reported the most past-and future-use of services. Conclusions Younger women are particularly vulnerable to experiencing

  13. Patient's and health care provider's perspectives on music therapy in palliative care - an integrative review.

    Science.gov (United States)

    Schmid, W; Rosland, J H; von Hofacker, S; Hunskår, I; Bruvik, F

    2018-02-20

    The use of music as therapy in multidisciplinary end-of-life care dates back to the 1970s and nowadays music therapy (MT) is one of the most frequently used complementary therapy in in-patient palliative care in the US. However existing research investigated music therapy's potential impact mainly from one perspective, referring to either a quantitative or qualitative paradigm. The aim of this review is to provide an overview of the users' and providers' perspectives on music therapy in palliative care within one research article. A systematic literature search was conducted using several databases supplemented with a hand-search of journals between November 1978 and December 2016. Inclusion criteria were: Music therapy with adults in palliative care conducted by a certified music therapist. Both quantitative and qualitative studies in English, German or a Scandinavian language published in peer reviewed journals were included. We aimed to identify and discuss the perspectives of both patients and health care providers on music therapy's impact in palliative care to forward a comprehensive understanding of it's effectiveness, benefits and limitations. We investigated themes mentioned by patients within qualitative studies, as well as commonly chosen outcome measures in quantitative research. A qualitative approach utilizing inductive content analysis was carried out to analyze and categorize the data. Twelve articles, reporting on nine quantitative and three qualitative research studies were included. Seven out of the nine quantitative studies investigated pain as an outcome. All of the included quantitative studies reported positive effects of the music therapy. Patients themselves associated MT with the expression of positive as well as challenging emotions and increased well-being. An overarching theme in both types of research is a psycho-physiological change through music therapy. Both quantitative as well as qualitative research showed positive changes in

  14. Creating a safer workplace to provide quality care.

    Science.gov (United States)

    Simmons, J C

    2001-04-01

    In recent years, increasing interest has been placed on how health care workers can be trained and equipped to better protect them from possible workplace accidents and injuries while improving the care they deliver. Better workplace safety also means better customer and employee satisfaction, improved workforce retention and recruitment, and cost savings. Workplace safety is constantly evolving and addresses a whole host of issues ranging from needles and sharps injuries to moving patients to human factor analyses. This issue takes a cross-sectional look at how hospitals and health systems are addressing problem areas--and sharing information and best practices--to strengthen their quality of care at the workplace level.

  15. Depression treatment for impoverished mothers by point-of-care providers: A randomized controlled trial.

    Science.gov (United States)

    Segre, Lisa S; Brock, Rebecca L; O'Hara, Michael W

    2015-04-01

    Depression in low-income, ethnic-minority women of childbearing age is prevalent and compromises infant and child development. Yet numerous barriers prevent treatment delivery. Listening Visits (LV), an empirically supported intervention developed for delivery by British home-visiting nurses, could address this unmet mental health need. This randomized controlled trial (RCT) evaluated the effectiveness of LV delivered at a woman's usual point-of-care, including home visits or an ob-gyn office. Listening Visits were delivered to depressed pregnant women or mothers of young children by their point-of-care provider (e.g., home visitor or physician's assistant), all of whom had low levels of prior counseling experience. Three quarters of the study's participants were low-income. Of those who reported ethnicity, all identified themselves as minorities. Participants from 4 study sites (N = 66) were randomized in a 2:1 ratio, to LV or a wait-list control group (WLC). Assessments, conducted at baseline and 8 weeks, evaluated depression, quality of life, and treatment satisfaction. Depressive severity, depressive symptoms, and quality of life significantly improved among LV recipients as compared with women receiving standard social/health services. Women valued LV as evidenced by their high attendance rates and treatment satisfaction ratings. In a stepped model of depression care, LV can provide an accessible, acceptable, and effective first-line treatment option for at-risk women who otherwise are unlikely to receive treatment. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

  16. Reframing Conscientious Care: Providing Abortion Care When Law and Conscience Collide.

    Science.gov (United States)

    Buchbinder, Mara; Lassiter, Dragana; Mercier, Rebecca; Bryant, Amy; Lyerly, Anne Drapkin

    2016-01-01

    Much of the debate on conscience has addressed the ethics of refusal: the rights of providers to refuse to perform procedures to which they object and the interests of the patients who might be harmed by their refusals. But conscience can also be a positive force, grounding decision about offering care.

  17. Community Health Centers: Providers, Patients, and Content of Care

    Science.gov (United States)

    ... can be more easily delivered than specialty and inpatient care, and if properly distributed could be effective ... services : Include education about asthma, diet and nutrition, exercise, growth and development, injury prevention, stress management, tobacco ...

  18. The Quality of Care Provided to Patients with Chronic Non ...

    African Journals Online (AJOL)

    Communicable Diseases is very low in both settings though it is relatively better in Jimma University Specialized Hospital. Therefore, a continuous process of quality improvement is recommended in both settings. KEYWORDS: Health care, Health ...

  19. Improving Health Care Provider Availability through Information Technology

    National Research Council Canada - National Science Library

    Lasell, Jon R

    2005-01-01

    .... This study identifies the need for change in collecting data on patient care time, reviews different methods/systems for gathering data, documents the implementation of the selected system (eUCAPERS...

  20. Not Babysitting: Work Stress and Well-Being for Family Child Care Providers

    Science.gov (United States)

    Gerstenblatt, Paula; Faulkner, Monica; Lee, Ahyoung; Doan, Linh Thy; Travis, Dnika

    2014-01-01

    Family child care providers contend with a number of work stressors related to the dual roles of operating a small business and providing child care in their home. Research has documented many sources of work related stress for family child care providers; however, research examining family child care providers' experiences outside of the…

  1. Native American Death Taboo: Implications for Health Care Providers.

    Science.gov (United States)

    Colclough, Yoshiko Yamashita

    2017-07-01

    This study was conducted to highlight Native American (NA) perspectives on death taboo in order to examine the cultural appropriateness of hospice services for NA patients, if any. Searching literature that addressed taboo and death from historical, psychological, sociological, and anthropological aspects, a comparison of death perspectives was made between NAs and European Americans. A culturally sensitive transition from palliative care to hospice care was suggested for NA patients and their family.

  2. A conceptual model: Redesigning how we provide palliative care for patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Philip, Jennifer; Crawford, Gregory; Brand, Caroline; Gold, Michelle; Miller, Belinda; Hudson, Peter; Smallwood, Natasha; Lau, Rosalind; Sundararajan, Vijaya

    2017-05-31

    Despite significant needs, patients with chronic obstructive pulmonary disease (COPD) make limited use of palliative care, in part because the current models of palliative care do not address their key concerns. Our aim was to develop a tailored model of palliative care for patients with COPD and their family caregivers. Based on information gathered within a program of studies (qualitative research exploring experiences, a cohort study examining service use), an expert advisory committee evaluated and integrated data, developed responses, formulated principles to inform care, and made recommendations for practice. The informing studies were conducted in two Australian states: Victoria and South Australia. A series of principles underpinning the model were developed, including that it must be: (1) focused on patient and caregiver; (2) equitable, enabling access to components of palliative care for a group with significant needs; (3) accessible; and (4) less resource-intensive than expansion of usual palliative care service delivery. The recommended conceptual model was to have the following features: (a) entry to palliative care occurs routinely triggered by clinical transitions in care; (b) care is embedded in routine ambulatory respiratory care, ensuring that it is regarded as "usual" care by patients and clinicians alike; (c) the tasks include screening for physical and psychological symptoms, social and community support, provision of information, and discussions around goals and preferences for care; and (d) transition to usual palliative care services is facilitated as the patient nears death. Our proposed innovative and conceptual model for provision of palliative care requires future formal testing using rigorous mixed-methods approaches to determine if theoretical propositions translate into effectiveness, feasibility, and benefits (including economic benefits). There is reason to consider adaptation of the model for the palliative care of patients with

  3. Primary care provider perceptions of intake transition records and shared care with outpatient cardiac rehabilitation programs

    Directory of Open Access Journals (Sweden)

    Jamnik Veronica

    2011-09-01

    Full Text Available Abstract Background While it is recommended that records are kept between primary care providers (PCPs and specialists during patient transitions from hospital to community care, this communication is not currently standardized. We aimed to assess the transmission of cardiac rehabilitation (CR program intake transition records to PCPs and to explore PCPs' needs in communication with CR programs and for intake transition record content. Method 144 PCPs of consenting enrollees from 8 regional and urban Ontario CR programs participated in this cross-sectional study. Intake transition records were tracked from the CR program to the PCP's office. Sixty-six PCPs participated in structured telephone interviews. Results Sixty-eight (47.6% PCPs received a CR intake transition record. Fifty-eight (87.9% PCPs desired intake transition records, with most wanting it transmitted via fax (n = 52, 78.8%. On a 5-point Likert scale, PCPs strongly agreed that the CR transition record met their needs for providing patient care (4.32 ± 0.61, with 48 (76.2% reporting that it improved their management of patients' cardiac risk. PCPs rated the following elements as most important to include in an intake transition record: clinical status (4.67 ± 0.64, exercise test results (4.61 ± 0.52, and the proposed patient care plan (4.59 ± 0.71. Conclusions Less than half of intake transition records are reaching PCPs, revealing a large gap in continuity of patient care. PCP responses should be used to develop an evidence-based intake transition record, and procedures should be implemented to ensure high-quality transitional care.

  4. Challenges faced by hospitals in providing surgical care and ...

    African Journals Online (AJOL)

    Esem

    essential surgical staff, inadequate funding, poor state of ... individuals interested in surgical care in the developing world has been ... 5.69 per 100,000 in the United States . ... categorical variables e.g gender, the percentage of the ... lack of materials and supplies to be used, inability to pay ... Confirming a big gap in.

  5. Balance of power shifts when providing care in patients' homes.

    Science.gov (United States)

    Sander, Ruth

    2011-06-01

    Nursing practice at home involves entering a place where the patient's and family's values and habits predominate. In hospital, nurses work in safe territory with the aid of conferred authority but this manner might not be suitable in a patient's own home. When people need nursing care, the meaning of home is at risk of changing.

  6. Providing antiretroviral therapy in rural areas: acute or chronic care?

    African Journals Online (AJOL)

    basis we see patients with stab wounds, children with life-threatening dehydration, adults with severe disseminated ... care; maternal and child health; and TB. She is the Eastern Cape .... cause headaches in migraine sufferers, this allowed them to study an alcohol-induced headache without the complication of intoxication.

  7. Problems experienced by professional nurses providing care for HIV ...

    African Journals Online (AJOL)

    The nurses reported feelings of frustrations, treatment delay, lack of knowledge on HIV and AIDS, lack of support systems and work overload as challenges faced in caring for HIV/AIDS patients. The need for in-service education for professional nurses on treatment of HIV positive patients was discussed and recommended.

  8. Experiences of health care providers managing sexual assault ...

    African Journals Online (AJOL)

    ... participate in matters pertaining to sexual assault. Government should develop clear guidelines that are applicable to rural and urban South Africa. Health care sciences should aim to train more forensic nurses. All relevant departments should work together to alleviate the complications caused by sexual assault incidents ...

  9. Modelling the cost-effectiveness of pregabalin versus usual care in daily practice in the treatment of refractory generalised anxiety disorder in Spain.

    Science.gov (United States)

    De Salas-Cansado, Marina; Álvarez, Enrique; Olivares, José M; Carrasco, Jose L; Ferro, M Belén; Rejas, Javier

    2013-06-01

    To model the cost-effectiveness (CEA) of the use of pregabalin versus usual care (UC) in outpatients with refractory generalised anxiety disorder (GAD) treated in daily practice in mental health settings in Spain. This CEA model used data extracted from a 6-month prospective non-interventional trial: the Amplification of Definition of ANxiety (ADAN) study, which was conducted to determine the cost-of-illness in GAD subjects. Refractory subjects were those who reported persistent symptoms of anxiety and showed suboptimal response in the Hamilton-anxiety scale (HAM-A ≥ 16) after a standard dose regimen of anxiolytics other than pregabalin, alone or in combination, over 6 months. The pregabalin arm was documented with data extracted from patients who received pregabalin in the study for the first time, added or replacing the existing therapy. In the UC arm, treatment might include one or more of the following: a serotonin selective reuptake inhibitor, a serotonin-norepinephrine reuptake inhibitor, other anti-depressants, a benzodiazepine or an anti-epileptic drug other than pregabalin. The time horizon of the modelling was 6 months in the base-case scenario, and the National Health System perspective was chosen to calculate costs. Effectiveness was expressed as quality-adjusted life years (QALYs) gained, which were derived using the EQ-5D questionnaire, at baseline and end-of-trial visits. Results of the CEA model was expressed as an incremental cost-effectiveness ratio (ICER) per QALY gained. Probabilistic sensitivity analysis using bootstrapping techniques was also carried out to obtain the cost-effectiveness plane and the corresponding acceptability curve. Data from a total of 429 subjects per arm (mean HAM-A score 25.7) meeting eligible criteria for inclusion in CEA modelling were extracted from the original trial. Compared with UC, pregabalin (average dose 218 mg/day) was associated with significantly higher QALY gain; 0.1209 ± 0.1030 versus 0.0994

  10. The effectiveness of Stepping stones Triple P: the design of a randomised controlled trial on a parenting programme regarding children with mild intellectual disability and psychosocial problems versus care as usual

    Science.gov (United States)

    2011-01-01

    Background Children with an intellectual disability are at increased risk of psychosocial problems. This leads to serious restrictions in the daily functioning of the children and to parental stress. Stepping Stones Triple P aims to prevent severe behavioural, emotional and developmental problems in children with a (intellectual) disability by enhancing parenting knowledge and skills, and the self-confidence of parents. This paper aims to describe the design of a study of the effectiveness of parenting counselling using Stepping Stones Triple P compared to Care as Usual. Methods/Design The effects of Stepping Stones Triple P will be studied in a Randomised Controlled Trial. Parents of children aged 5-12 years with an IQ of 50-85 will be recruited from schools. Prior to randomisation, parents complete a screening questionnaire about their child's psychosocial problems and their parenting skills. Subsequently, parents of children with increased levels of psychosocial problems (score on Strengths and Difficulties Questionnaire ≥ 14) will be invited to participate in the intervention study. After obtaining consent, parents will be randomised either to the experimental group (Stepping Stones Triple P) or to Care as Usual. The primary outcome is a change in the child's psychosocial problems according to parents and teachers. The secondary outcome is a change in parenting skills. Data will be collected before the start of the intervention, immediately after the intervention, and six months after. Discussion This paper presents an outline of the background and design of a randomised controlled trial to investigate the effectiveness of Stepping Stones Triple P, which aims to decrease psychosocial problems in children with a mild intellectual disability. Stepping Stones Triple P seems promising, but evidence on its effectiveness for this population is still lacking. This study provides evidence about the effects of this intervention in a community-based population of

  11. The effectiveness of Stepping Stones Triple P: the design of a randomised controlled trial on a parenting programme regarding children with mild intellectual disability and psychosocial problems versus care as usual.

    Science.gov (United States)

    Kleefman, Marijke; Jansen, Daniëlle E M C; Reijneveld, Sijmen A

    2011-08-30

    Children with an intellectual disability are at increased risk of psychosocial problems. This leads to serious restrictions in the daily functioning of the children and to parental stress. Stepping Stones Triple P aims to prevent severe behavioural, emotional and developmental problems in children with a (intellectual) disability by enhancing parenting knowledge and skills, and the self-confidence of parents. This paper aims to describe the design of a study of the effectiveness of parenting counselling using Stepping Stones Triple P compared to Care as Usual. The effects of Stepping Stones Triple P will be studied in a Randomised Controlled Trial. Parents of children aged 5-12 years with an IQ of 50-85 will be recruited from schools. Prior to randomisation, parents complete a screening questionnaire about their child's psychosocial problems and their parenting skills. Subsequently, parents of children with increased levels of psychosocial problems (score on Strengths and Difficulties Questionnaire ≥ 14) will be invited to participate in the intervention study. After obtaining consent, parents will be randomised either to the experimental group (Stepping Stones Triple P) or to Care as Usual. The primary outcome is a change in the child's psychosocial problems according to parents and teachers. The secondary outcome is a change in parenting skills. Data will be collected before the start of the intervention, immediately after the intervention, and six months after. This paper presents an outline of the background and design of a randomised controlled trial to investigate the effectiveness of Stepping Stones Triple P, which aims to decrease psychosocial problems in children with a mild intellectual disability. Stepping Stones Triple P seems promising, but evidence on its effectiveness for this population is still lacking. This study provides evidence about the effects of this intervention in a community-based population of children with a mild intellectual

  12. The effectiveness of Stepping stones Triple P: the design of a randomised controlled trial on a parenting programme regarding children with mild intellectual disability and psychosocial problems versus care as usual

    Directory of Open Access Journals (Sweden)

    Jansen Daniëlle EMC

    2011-08-01

    Full Text Available Abstract Background Children with an intellectual disability are at increased risk of psychosocial problems. This leads to serious restrictions in the daily functioning of the children and to parental stress. Stepping Stones Triple P aims to prevent severe behavioural, emotional and developmental problems in children with a (intellectual disability by enhancing parenting knowledge and skills, and the self-confidence of parents. This paper aims to describe the design of a study of the effectiveness of parenting counselling using Stepping Stones Triple P compared to Care as Usual. Methods/Design The effects of Stepping Stones Triple P will be studied in a Randomised Controlled Trial. Parents of children aged 5-12 years with an IQ of 50-85 will be recruited from schools. Prior to randomisation, parents complete a screening questionnaire about their child's psychosocial problems and their parenting skills. Subsequently, parents of children with increased levels of psychosocial problems (score on Strengths and Difficulties Questionnaire ≥ 14 will be invited to participate in the intervention study. After obtaining consent, parents will be randomised either to the experimental group (Stepping Stones Triple P or to Care as Usual. The primary outcome is a change in the child's psychosocial problems according to parents and teachers. The secondary outcome is a change in parenting skills. Data will be collected before the start of the intervention, immediately after the intervention, and six months after. Discussion This paper presents an outline of the background and design of a randomised controlled trial to investigate the effectiveness of Stepping Stones Triple P, which aims to decrease psychosocial problems in children with a mild intellectual disability. Stepping Stones Triple P seems promising, but evidence on its effectiveness for this population is still lacking. This study provides evidence about the effects of this intervention in a community

  13. Can We Help Care Providers Communicate More Effectively With Persons Having Dementia Living in Long-Term Care Homes?

    Science.gov (United States)

    Rochon, Elizabeth; Sidani, Souraya; Shaw, Alexander; Ben-David, Boaz M.; Saragosa, Marianne; Boscart, Veronique M.; Wilson, Rozanne; Galimidi-Epstein, Karmit K.

    2016-01-01

    Background: Effective communication between residents with dementia and care providers in long-term care homes (LTCHs) is essential to resident-centered care. Purpose: To determine the effects of a communication intervention on residents’ quality of life (QOL) and care, as well as care providers’ perceived knowledge, mood, and burden. Method: The intervention included (1) individualized communication plans, (2) a dementia care workshop, and (3) a care provider support system. Pre- and postintervention scores were compared to evaluate the effects of the intervention. A total of 12 residents and 20 care providers in an LTCH participated in the feasibility study. Results: The rate of care providers’ adherence to the communication plans was 91%. Postintervention, residents experienced a significant increase in overall QOL. Care providers had significant improvement in mood and perceived reduced burden. Conclusion: The results suggest that the communication intervention demonstrates preliminary evidence of positive effects on residents’ QOL and care providers’ mood and burden. PMID:27899433

  14. Effectiveness of rehabilitation after a total hip arthroplasty : A protocol for an observational study for the comparison of usual care in the Netherlands versus Germany

    NARCIS (Netherlands)

    Seeber, Gesine H; Wijnen, Annet; Lazovic, Djordje; Bulstra, Sjoerd K; Dietz, Günter; van Lingen, Christiaan P; Stevens, Martin

    Introduction Osteoarthritis is the most common joint disorder worldwide. Total hip arthroplasty (THA) is considered one of the most effective treatments for end-stage hip osteoarthritis. The number of THAs is expected to increase dramatically in the coming decades. Usual postoperative rehabilitation

  15. Medicaid Personal Care Services for Children with Intellectual Disabilities: What Assistance Is Provided? When Is Assistance Provided?

    Science.gov (United States)

    Elliot, Timothy R.; Patnaik, Ashweeta; Naiser, Emily; Fournier, Constance J.; McMaughan, Darcy K.; Dyer, James A.; Phillips, Charles D.

    2014-01-01

    We report on the nature and timing of services provided to children with an intellectual disability (ID) identified by a new comprehensive assessment and care planning tool used to evaluate children's needs for Medicaid Personal Care Services (PCS) in Texas. The new assessment procedure resulted from a legal settlement with the advocacy community.…

  16. Managed care and clinical decision-making in child and adolescent behavioral health: provider perceptions.

    Science.gov (United States)

    Yanos, Philip T; Garcia, Christine I; Hansell, Stephen; Rosato, Mark G; Minsky, Shula

    2003-03-01

    This study investigated how managed care affects clinical decision-making in a behavioral health care system. Providers serving children and adolescents under both managed and unmanaged care (n = 28) were interviewed about their awareness of differences between the benefit arrangements, how benefits affect clinical decision-making, outcomes and quality of care; and satisfaction with care. Quantitative and qualitative findings indicated that providers saw both advantages and disadvantages to managed care. Although most providers recognized the advantages of managed care in increasing efficiency, many were concerned that administrative pressures associated with managed care compromise service quality.

  17. An Economic Evaluation of TENS in Addition to Usual Primary Care Management for the Treatment of Tennis Elbow: Results from the TATE Randomized Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Martyn Lewis

    Full Text Available The TATE trial was a multicentre pragmatic randomized controlled trial of supplementing primary care management (PCM-consisting of a GP consultation followed by information and advice on exercises-with transcutaneous electrical nerve stimulation (TENS, to reduce pain intensity in patients with tennis elbow. This paper reports the health economic evaluation.Adults with new diagnosis of tennis elbow were recruited from 38 general practices in the UK, and randomly allocated to PCM (n = 120 or PCM plus TENS (n = 121. Outcomes included reduction in pain intensity and quality-adjusted-life-years (QALYs based on the EQ5D and SF6D. Two economic perspectives were evaluated: (i healthcare-inclusive of NHS and private health costs for the tennis elbow; (ii societal-healthcare costs plus productivity losses through work absenteeism. Mean outcome and cost differences between the groups were evaluated using a multiple imputed dataset as the base case evaluation, with uncertainty represented in cost-effectiveness planes and through probabilistic cost-effectiveness acceptability curves. Incremental healthcare cost was £33 (95%CI -40, 106 and societal cost £65 (95%CI -307, 176 for PCM plus TENS. Mean differences in outcome were: 0.11 (95%CI -0.13, 0.35 for change in pain (0-10 pain scale; -0.015 (95%CI -0.058, 0.029 for QALYEQ5D; 0.007 (95%CI -0.022, 0.035 for QALYSF6D (higher score differences denote greater benefit for PCM plus TENS. The ICER (incremental cost effectiveness ratio for the main evaluation of mean difference in societal cost (£ relative to mean difference in pain outcome was -582 (95%CI -8666, 8113. However, incremental ICERs show differences in cost-effectiveness of additional TENS, according to the outcome being evaluated.Our findings do not provide evidence for or against the cost-effectiveness of TENS as an adjunct to primary care management of tennis elbow.

  18. An Intervention to Enhance Goals-of-Care Communication Between Heart Failure Patients and Heart Failure Providers.

    Science.gov (United States)

    Doorenbos, Ardith Z; Levy, Wayne C; Curtis, J Randall; Dougherty, Cynthia M

    2016-09-01

    Heart failure patients contend with a markedly impaired quality of life, experiencing emotional distress and severe physical discomfort that increases in frequency in the last months of life. Improving communication between patients and providers about goals of care has the potential to improve patient-provider communication and patient outcomes. To determine the effects of a goals-of-care (GoC) intervention compared to usual care on the number of GoC conversations, quality of communication between patients and providers, referrals to palliative care services and completion of advance care directives. A two-group randomized study (n = 40/group) compared a GoC intervention to usual care, conducted in an academic heart failure (HF) clinic. The GoC intervention was a previsit patient activation-education, telephone-based intervention delivered by a nurse. The primary outcome of the study was number of GoC conversations between HF patients and HF providers. Secondary outcomes were quality of communication, number of referrals to palliative care, and completion of advance directives. Patients averaged 58.15 ± 11.26 years of age, with mean left ventricular ejection fraction = 30.31 ± 9.72% and Seattle Heart Failure Model scores = 95.1 ± 1.60. There was a significant increase in goals-of-care conversations (58% vs. 2.6%, P communication (P = 0.03) in the GoC group compared to usual care after the intervention. There were no differences between groups on the other outcomes. The GoC intervention resulted in more GoC conversations and higher quality communication between HF patients and providers without increased anxiety or depression. Further studies are needed to assess impact on longer term quality of care and patient outcomes. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  19. 25 CFR 20.507 - What requirements must foster care providers meet?

    Science.gov (United States)

    2010-04-01

    ... ASSISTANCE AND SOCIAL SERVICES PROGRAMS Child Assistance Foster Care § 20.507 What requirements must foster care providers meet? If a child needs foster care, the social services worker must select care that... contain an approved current home study. (c) An off-reservation foster home, or residential care facility...

  20. Antenatal and obstetric care in Afghanistan--a qualitative study among health care receivers and health care providers.

    Science.gov (United States)

    Rahmani, Zuhal; Brekke, Mette

    2013-05-06

    Despite attempts from the government to improve ante- and perinatal care, Afghanistan has once again been labeled "the worst country in which to be a mom" in Save the Children's World's Mothers' Report. This study investigated how pregnant women and health care providers experience the existing antenatal and obstetric health care situation in Afghanistan. Data were obtained through one-to-one semi-structured interviews of 27 individuals, including 12 women who were pregnant or had recently given birth, seven doctors, five midwives, and three traditional birth attendants. The interviews were carried out in Kabul and the village of Ramak in Ghazni Province. Interviews were taped, transcribed, and analyzed according to the principles of Giorgi's phenomenological analysis. Antenatal care was reported to be underused, even when available. Several obstacles were identified, including a lack of knowledge regarding the importance of antenatal care among the women and their families, financial difficulties, and transportation problems. The women also reported significant dissatisfaction with the attitudes and behavior of health personnel, which included instances of verbal and physical abuse. According to the health professionals, poor working conditions, low salaries, and high stress levels contributed to this matter. Personal contacts inside the hospital were considered necessary for receiving high quality care, and bribery was customary. Despite these serious concerns, the women expressed gratitude for having even limited access to health care, especially treatment provided by a female doctor. Health professionals were proud of their work and enjoyed the opportunity to help their community. This study identified several obstacles which must be addressed to improve reproductive health in Afghanistan. There was limited understanding of the importance of antenatal care and a lack of family support. Financial and transportation problems led to underuse of available care

  1. Three-year follow-up of 3-year-old to 5-year-old children after participation in a multidisciplinary or a usual-care obesity treatment program

    NARCIS (Netherlands)

    Bocca, Gianni; Corpeleijn, Eva; van den Heuvel, Edwin R.; Stolk, Ronald P.; Sauer, Pieter J. J.

    2014-01-01

    Background & aims: Little is known on the long-term effects of obesity intervention programs in preschool-aged children. We compared the long-term effects of a multidisciplinary treatment program with a usual-care program in seventy-five 3- to 5-year-old overweight or obese children who had

  2. Providing support to doctors working in intensive care

    LENUS (Irish Health Repository)

    Murphy, JFA

    2012-05-01

    ‘Jading’ is a process of exhaustion in which apathy and cynicism replace the drive to be responsive and caring. ‘Burnout’ a term first coined in the psychology literature in 1974 was based on Graham Greene’s novel ‘A Burnt-Out Case1. It is the umbrella description for disengagement in the workplace setting characterised by withdrawal, denial and inefficiency. There is an alienation from the pressures of work. Marshall and Kasman2 defined it as ‘the loss of motivation for creative thought’. It is the opposite of engagement which is associated with energy and optimism. People who experience all 3 symptoms- emotional exhaustion, negative attitude towards patients, reduced sense of personal accomplishment- have the greatest degree of burnout. It doesn’t get better by being ignored. These processes have serious consequences for the individual involved and the hospital that they work in. The doctor underperforms and the Unit becomes dysfunctional There is decreased quality of care, increased absenteeism, and high staff turnover. There is an inability to make decisions and a failure to set priorities.

  3. Palliative Care in Cancer

    Science.gov (United States)

    ... care is usually provided by palliative care specialists, health care practitioners who have received special training and/or certification in palliative care. They provide holistic care to the patient and family or caregiver ...

  4. factors influencing the choice of health care providing facility among

    African Journals Online (AJOL)

    In the public sector ... Objectives: This study aimed to assess the factors influencing choice and satisfaction with health service providers among local ... the consumer of healthcare services cannot control. ..... Acquisition of Stable Food.

  5. Pharmacists in primary care. Determinants of the care-providing function of Dutch community pharmacists in primary care.

    NARCIS (Netherlands)

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

    2004-01-01

    OBJECTIVE: To identify determinants of the care-providing function of the community pharmacists (CPs) to explain variations in professional practice. SETTING: The Netherlands 2001. PARTICIPANTS: 328 CPs. METHOD: A cross-sectional questionnaire survey was performed. Questionnaires were used to

  6. The effect of financial incentives on the quality of health care provided by primary care physicians.

    Science.gov (United States)

    Scott, Anthony; Sivey, Peter; Ait Ouakrim, Driss; Willenberg, Lisa; Naccarella, Lucio; Furler, John; Young, Doris

    2011-09-07

    The use of blended payment schemes in primary care, including the use of financial incentives to directly reward 'performance' and 'quality' is increasing in a number of countries. There are many examples in the US, and the Quality and Outcomes Framework (QoF) for general practitioners (GPs) in the UK is an example of a major system-wide reform. Despite the popularity of these schemes, there is currently little rigorous evidence of their success in improving the quality of primary health care, or of whether such an approach is cost-effective relative to other ways to improve the quality of care. The aim of this review is to examine the effect of changes in the method and level of payment on the quality of care provided by primary care physicians (PCPs) and to identify:i) the different types of financial incentives that have improved quality;ii) the characteristics of patient populations for whom quality of care has been improved by financial incentives; andiii) the characteristics of PCPs who have responded to financial incentives. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Database of Systematic Reviews (CDSR) (The Cochrane Library), MEDLINE, HealthSTAR, EMBASE, CINAHL, PsychLIT, and ECONLIT. Searches of Internet-based economics and health economics working paper collections were also conducted. Finally, studies were identified through the reference lists of retrieved articles, websites of key organisations, and from direct contact with key authors in the field. Articles were included if they were published from 2000 to August 2009. Randomised controlled trials (RCT), controlled before and after studies (CBA), and interrupted time series analyses (ITS) evaluating the impact of different financial interventions on the quality of care delivered by primary healthcare physicians (PCPs). Quality of care was defined as patient reported outcome

  7. Benchmarking facilities providing care: An international overview of initiatives

    Science.gov (United States)

    Thonon, Frédérique; Watson, Jonathan; Saghatchian, Mahasti

    2015-01-01

    We performed a literature review of existing benchmarking projects of health facilities to explore (1) the rationales for those projects, (2) the motivation for health facilities to participate, (3) the indicators used and (4) the success and threat factors linked to those projects. We studied both peer-reviewed and grey literature. We examined 23 benchmarking projects of different medical specialities. The majority of projects used a mix of structure, process and outcome indicators. For some projects, participants had a direct or indirect financial incentive to participate (such as reimbursement by Medicaid/Medicare or litigation costs related to quality of care). A positive impact was reported for most projects, mainly in terms of improvement of practice and adoption of guidelines and, to a lesser extent, improvement in communication. Only 1 project reported positive impact in terms of clinical outcomes. Success factors and threats are linked to both the benchmarking process (such as organisation of meetings, link with existing projects) and indicators used (such as adjustment for diagnostic-related groups). The results of this review will help coordinators of a benchmarking project to set it up successfully. PMID:26770800

  8. Implementation strategies of internet-based asthma self-management support in usual care. Study protocol for the IMPASSE cluster randomized trial.

    Science.gov (United States)

    van Gaalen, Johanna L; Bakker, Moira J; van Bodegom-Vos, Leti; Snoeck-Stroband, Jiska B; Assendelft, Willem J J; Kaptein, Ad A; van der Meer, Victor; Taube, Christian; Thoonen, Bart P; Sont, Jacob K

    2012-11-21

    Internet-based self-management (IBSM) support cost-effectively improves asthma control, asthma related quality of life, number of symptom-free days, and lung function in patients with mild to moderate persistent asthma. The current challenge is to implement IBSM in clinical practice. This study is a three-arm cluster randomized trial with a cluster pre-randomisation design and 12 months follow-up per practice comparing the following three IBSM implementation strategies: minimum strategy (MS): dissemination of the IBSM program; intermediate strategy (IS): MS + start-up support for professionals (i.e., support in selection of the appropriate population and training of professionals); and extended strategy (ES): IS + additional training and ongoing support for professionals. Because the implementation strategies (interventions) are primarily targeted at general practices, randomisation will occur at practice level.In this study, we aim to evaluate 14 primary care practices per strategy in the Leiden-The Hague region, involving 140 patients per arm. Patients aged 18 to 50 years, with a physician diagnosis of asthma, prescription of inhaled corticosteroids, and/or montelukast for ≥3 months in the previous year are eligible to participate. Primary outcome measures are the proportion of referred patients that participate in IBSM, and the proportion of patients that have clinically relevant improvement in the asthma-related quality of life. The secondary effect measures are clinical outcomes (asthma control, lung function, usage of airway treatment, and presence of exacerbations); self-management related outcomes (health education impact, medication adherence, and illness perceptions); and patient utilities. Process measures are the proportion of practices that participate in IBSM and adherence of professionals to implementation strategies. Cost-effective measurements are medical costs and healthcare consumption. Follow-up is six months per patient. This study

  9. Implementation strategies of internet-based asthma self-management support in usual care. Study protocol for the IMPASSE cluster randomized trial

    Directory of Open Access Journals (Sweden)

    van Gaalen Johanna L

    2012-11-01

    Full Text Available Abstract Background Internet-based self-management (IBSM support cost-effectively improves asthma control, asthma related quality of life, number of symptom-free days, and lung function in patients with mild to moderate persistent asthma. The current challenge is to implement IBSM in clinical practice. Methods/design This study is a three-arm cluster randomized trial with a cluster pre-randomisation design and 12 months follow-up per practice comparing the following three IBSM implementation strategies: minimum strategy (MS: dissemination of the IBSM program; intermediate strategy (IS: MS + start-up support for professionals (i.e., support in selection of the appropriate population and training of professionals; and extended strategy (ES: IS + additional training and ongoing support for professionals. Because the implementation strategies (interventions are primarily targeted at general practices, randomisation will occur at practice level. In this study, we aim to evaluate 14 primary care practices per strategy in the Leiden-The Hague region, involving 140 patients per arm. Patients aged 18 to 50 years, with a physician diagnosis of asthma, prescription of inhaled corticosteroids, and/or montelukast for ≥3 months in the previous year are eligible to participate. Primary outcome measures are the proportion of referred patients that participate in IBSM, and the proportion of patients that have clinically relevant improvement in the asthma-related quality of life. The secondary effect measures are clinical outcomes (asthma control, lung function, usage of airway treatment, and presence of exacerbations; self-management related outcomes (health education impact, medication adherence, and illness perceptions; and patient utilities. Process measures are the proportion of practices that participate in IBSM and adherence of professionals to implementation strategies. Cost-effective measurements are medical costs and healthcare consumption

  10. Brand name changes help health care providers win market recognition.

    Science.gov (United States)

    Keesling, G

    1993-01-01

    As the healthcare industry continues to recognize the strategic implications of branding, more providers will undertake an identity change to better position themselves in competitive markets. The paper examines specific healthcare branding decisions, the reasons prompting brand name decisions and the marketing implications for a change in brand name.

  11. Integrating alternative providers into managed care: a case study.

    Science.gov (United States)

    Broida, M

    1997-09-01

    Alternative medical techniques have become extremely popular, particularly in the western United States. Washington State recently enacted a law requiring certain health plans to include alternative providers on their physician panels. The author describes the efforts of one MCO to comply.

  12. Pathways of Adult Children Providing Care to Older Parents

    Science.gov (United States)

    Barnett, Amanda E.

    2013-01-01

    Guided by life course and stress process theory, this study investigated pathways of adult child caregivers' family (caregiving, marital, parenting) and nonfamily (employment) roles. Eight waves of data from the Health and Retirement Study were analyzed for 1,300 adult child caregivers. Latent class analysis provided strong evidence for a 4-class…

  13. Determinants of the Level of Care Provided for Various Types and Sizes of Dogs in New Providence, The Bahamas

    Directory of Open Access Journals (Sweden)

    Fielding, William J.

    2010-01-01

    Full Text Available This paper reports the level of care offered 424 dogs, classified as small dogs, large dogs, pit bulls and potcakes (the colloquial name for the local mongrel in New Providence, The Bahamas. Levels of care that meet the legal minimum –food water and shelter– as well as care considered essential and enriched in The Bahamas were less common for large dogs than small dogs. Small dogs tended to get more care than other dogs and so were at lowest risk of being neglected.It is suggested that the size of the dog is an important factor which determines the level of care provided. Pit bulls generally received similar care to potcakes which are often considered neglected. Large dogs were more likely to be kept outside and less likely to be allowed inside the home than small dogs. It is conjectured that in many instances the level of care offered constitutes partial abandonment due to a lack of interaction between caregivers and their dogs.

  14. Better Together: Co-Location of Dental and Primary Care Provides Opportunities to Improve Oral Health.

    Science.gov (United States)

    Pourat, Nadereh; Martinez, Ana E; Crall, James J

    2015-09-01

    Community Health Centers (CHCs) are one of the principal safety-net providers of health care for low-income and uninsured populations. Co-locating dental services in primary care settings provides an opportunity to improve access to dental care. Yet this study of California CHCs that provide primary care services shows that only about one-third of them co-located primary and dental care services on-site. An additional one-third were members of multisite organizations in which at least one other site provided dental care. The remaining one-third of CHC sites had no dental care capacity. Policy options to promote co-location include requiring on-site availability of dental services, providing infrastructure funding to build and equip dental facilities, and offering financial incentives to provide dental care and recruit dental providers.

  15. Factors that affect parent perceptions of provider-family partnership for children with special health care needs.

    Science.gov (United States)

    Knapp, Caprice A; Madden, Vanessa L; Marcu, Mircea I

    2010-09-01

    Partnering between families and their children's providers is a cornerstone of family-centered care. This study aimed to identify factors associated with family-provider partnership and determine the association between partnership and other outcome measures for children with special health care needs (CSHCN). Descriptive, bivariate, and multivariate analyses were conducted using data from the 2005-2006 National Survey of Children with Special Health Care Needs. Multivariate models showed that CSHCN who are White non-Hispanic, younger than 12, reside in households with incomes above 400% of the federal poverty level, and have a usual source of care were associated with family-provider partnership. Multivariate models showed that family-provider partnership was significantly associated with adequate insurance, early and continual screening, organized health care services, and transition preparedness. Family-provider partnership was associated with 20% fewer emergency department visits and 9% fewer school days missed. This study suggests that policies aimed at promoting family-provider partnership could increase health outcomes for CSHCN.

  16. Does Risk-Adjusted Payment Influence Primary Care Providers' Decision on Where to Set Up Practices?

    DEFF Research Database (Denmark)

    Dietrichson, Jens; Anell, Anders; Dackehag, Margareta

    Providing equal access to health care is an important objective in most health care systems. It is especially pertinent in systems like the Swedish primary care market, where providers are free to establish themselves in any part of the country. To improve equity in access to care, 15 out 21 county...... of private primary care centers in areas with unfavorable socioeconomic and demographic characteristics. More generally, this result indicates that risk-adjusted capitation can significantly affect private providers’ establishment decisions....

  17. Transforming Health Care Service Delivery and Provider Selection

    OpenAIRE

    Reiner, Bruce I.

    2011-01-01

    Commoditization pressures in medicine have risked transforming service provider selection from “survival of the fittest” to “survival of the cheapest.” Quality- and safety-oriented mandates by the Institute of Medicine have led to the creation of a number of data-driven quality-centric initiatives including Pay for Performance and Evidence-Based Medicine. A synergistic approach to creating quantitative accountability in medical service delivery is through the creation of consumer-oriented per...

  18. Cost analysis of consolidated federally provided health care

    Science.gov (United States)

    2017-06-01

    Government Accountability Office JIT just-in time KPO Kaizen promotion offices LT lead time MHS Military Health System MRI magnetic resonance...a hospital that is only large enough for one MRI unit may need to hold it idle much of the time to permit emergency testing; whereas, a hospital...Center San Diego and San Diego VA hospital both provide outpatient pharmaceutical services. Duplication and redundancy of operating two separate

  19. The meaning of providing caring to obese patients to a group of nurses

    Directory of Open Access Journals (Sweden)

    Emilly Souza Marques

    2014-03-01

    Full Text Available This qualitative study was performed with six nurses of a public hospital, with the objective to describe their view of the meaning of providing care to obese patients. Interviews were conducted using a semi-structured script. The data were organized under themes extracted from the subjects’ statements, after being thoroughly read. Symbolic Interactionism was adopted to interpret the findings. The results from the analysis were organized under the following themes: Being obese is excessive, it is not healthy; Providing care to the obese is a structural issue; Obese patients are troublesome, they require care, no big deal; Providing care to the obese requires teamwork. The grasped meanings can interfere in the care provided. The nurses, however, recognize the need to work as a team to deliver comprehensive care. Making positive changes to the meanings found in this study is possible, thus, contributing to providing prejudice-free nursing care to obese patients. Descriptors: Obesity; Nursing Care; Hospital Care.

  20. Attitudes of Scottish abortion care providers towards provision of abortion after 16 weeks' gestation within Scotland.

    Science.gov (United States)

    Cochrane, Rosemary A; Cameron, Sharon T

    2013-06-01

    In Scotland, in contrast to the rest of Great Britain, abortion at gestations over 20 weeks is not provided, and provision of procedures above 16 weeks varies considerably between regions. Women at varying gestations above 16 weeks must travel outside Scotland, usually to England, for the procedure. To determine the views of professionals working within Scottish abortion care about a Scottish late abortion service. Delegates at a meeting for abortion providers in Scotland completed a questionnaire about their views on abortion provision over 16 weeks and their perceived barriers to service provision. Of 95 distributed questionnaires, 70 (76%) were analysed. Fifty-six respondents (80%) supported a Scottish late abortion service, ten (14%) would maintain current service arrangements, and five (7%) were undecided. Forty (57%) of the supporters of a Scottish service would prefer a single national service, and 16 (22%) several regional services. Perceived barriers included lack of trained staff (n = 39; 56%), accommodation for the service (n = 34; 48%), and perception of lack of support among senior management (n = 28; 40%). The majority of health professionals surveyed who work in Scottish abortion services support provision of abortion beyond 16 weeks within Scotland, and most favour a single national service. Further work on the feasibility of providing this service is required.

  1. Critical care providers refer to information tools less during communication tasks after a critical care clinical information system introduction.

    Science.gov (United States)

    Ballermann, Mark; Shaw, Nicola T; Mayes, Damon C; Gibney, R T Noel

    2011-01-01

    Electronic documentation methods may assist critical care providers with information management tasks in Intensive Care Units (ICUs). We conducted a quasi-experimental observational study to investigate patterns of information tool use by ICU physicians, nurses, and respiratory therapists during verbal communication tasks. Critical care providers used tools less at 3 months after the CCIS introduction. At 12 months, care providers referred to paper and permanent records, especially during shift changes. The results suggest potential areas of improvement for clinical information systems in assisting critical care providers in ensuring informational continuity around their patients.

  2. Not the usual sinusitis

    Science.gov (United States)

    Ammar, Hussam; Kott, Amy; Fouda, Ragai

    2012-01-01

    An encephalocele is a protrusion of the cranial contents beyond the normal confines of the skull. It is a rare cause of seizure in adults. A 38-year-old woman presented with a first-onset seizure. Brain CT was interpreted as right frontal sinus opacification suggestive of sinusitis. The patient was discharged home with an amoxicillin prescription. A few days later, she was re-admitted with another seizure. Careful evaluation of the brain CT and MRI revealed a right frontal sinus posterior wall defect and possible brain encephalocele. The patient had complained of chronic nasal discharge for years and had also noticed a watery discharge from her right nostril. We suspected cerebrospinal fluid rhinorrhea. A bifrontal craniotomy was performed, the encephalocele was resected and cranialisation of the frontal sinus was completed. The patient remained free of seizures at the last follow-up. PMID:23188840

  3. Burnout and self-reported suboptimal patient care amongst health care workers providing HIV care in Malawi

    Science.gov (United States)

    Mazenga, Alick C.; Simon, Katie; Yu, Xiaoying; Ahmed, Saeed; Nyasulu, Phoebe; Kazembe, Peter N.; Ngoma, Stanley; Abrams, Elaine J.

    2018-01-01

    Background The well-documented shortages of health care workers (HCWs) in sub-Saharan Africa are further intensified by the increased human resource needs of expanding HIV treatment programs. Burnout is a syndrome of emotional exhaustion (EE), depersonalization (DP), and a sense of low personal accomplishment (PA). HCWs’ burnout can negatively impact the delivery of health services. Our main objective was to examine the prevalence of burnout amongst HCWs in Malawi and explore its relationship to self-reported suboptimal patient care. Methods A cross-sectional study among HCWs providing HIV care in 89 facilities, across eight districts in Malawi was conducted. Burnout was measured using the Maslach Burnout Inventory defined as scores in the mid-high range on the EE or DP subscales. Nine questions adapted for this study assessed self-reported suboptimal patient care. Surveys were administered anonymously and included socio-demographic and work-related questions. Validated questionnaires assessed depression and at-risk alcohol use. Chi-square test or two-sample t-test was used to explore associations between variables and self-reported suboptimal patient care. Bivariate analyses identified candidate variables (p burnout. In the three dimensions of burnout, 55% reported moderate-high EE, 31% moderate-high DP, and 46% low-moderate PA. The majority (89%) reported engaging in suboptimal patient care/attitudes including making mistakes in treatment not due to lack of knowledge/experience (52%), shouting at patients (45%), and not performing diagnostic tests due to a desire to finish quickly (35%). In multivariate analysis, only burnout remained associated with self-reported suboptimal patient care (OR 3.22, [CI 2.11 to 4.90]; pBurnout was common among HCWs providing HIV care and was associated with self-reported suboptimal patient care practices/attitudes. Research is needed to understand factors that contribute to and protect against burnout and that inform the

  4. Providing prenatal care to pregnant women with overweight or obesity: Differences in provider communication and ratings of the patient-provider relationship by patient body weight.

    Science.gov (United States)

    Washington Cole, Katie O; Gudzune, Kimberly A; Bleich, Sara N; Cheskin, Lawrence J; Bennett, Wendy L; Cooper, Lisa A; Roter, Debra L

    2017-06-01

    To examine the association of women's body weight with provider communication during prenatal care. We coded audio recordings of prenatal visits between 22 providers and 117 of their patients using the Roter Interaction Analysis System. Multivariate, multilevel Poisson models were used to examine the relationship between patient pre-pregnancy body mass index and provider communication. Compared to women with normal weight, providers asked fewer lifestyle questions (IRR 0.66, 95% CI 0.44-0.99, p=0.04) and gave less lifestyle information (IRR 0.51, 95% CI 0.32-0.82, p=0.01) to women with overweight and obesity, respectively. Providers used fewer approval (IRR 0.68, 95% CI 0.51-0.91, p=0.01) and concern statements (IRR 0.68, 95% CI 0.53-0.86, p=0.002) when caring for women with overweight and fewer self-disclosure statements caring for women with obesity (IRR 0.40, 95% CI 0.19-0.84 p=0.02). Less lifestyle and rapport building communication for women with obesity may weaken patient-provider relationship during routine prenatal care. Interventions to increase use of patient-centered communication - especially for women with overweight and obesity - may improve prenatal care quality. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  5. Diagnostic work-up of neurological syndromes in a rural African setting: knowledge, attitudes and practices of health care providers.

    Directory of Open Access Journals (Sweden)

    Alain Mpanya

    Full Text Available BACKGROUND: Neurological disorders of infectious origin are common in rural sub-Saharan Africa and usually have serious consequences. Unfortunately, these syndromes are often poorly documented for lack of diagnostic tools. Clinical management of these diseases is a major challenge in under-equipped rural health centers and hospitals. We documented health care provider knowledge, attitudes and practices related to this syndrome in two rural health zones in Bandundu Province, Democratic Republic of Congo. METHODS: We used a qualitative research approach combining observation, in-depth interviews and focus group discussions. We observed 20 patient-provider contacts related to a neurological syndrome, conducted 12 individual interviews and 4 focus group discussions with care providers. All interviews were audiotaped and the transcripts were analyzed with the software ATLAS.ti. RESULTS: Care providers in this region usually limit their diagnostic work-up to clinical examination primarily because of the financial hurdles in this entirely out-of-pocket payment system. The patients prefer to purchase drugs rather than diagnostic tests. Moreover the general lack of diagnostic tools and the representation of the clinician as a "diviner" do not enhance any use of laboratory or other diagnostic methods. CONCLUSION: Innovation in diagnostic technology for neurological disorders is badly needed in Central-Africa, but its uptake in clinical practice will only be a success if tools are simple, affordable and embedded in a patient-centered approach.

  6. Primary care providers and medical homes for individuals with spina bifida.

    Science.gov (United States)

    Walker, William O

    2008-01-01

    The contributions of primary care providers to the successful care of children with spina bifida cannot be underestimated. Overcoming systemic barriers to their integration into a comprehensive care system is essential. By providing routine and disability specific care through the structure of a Medical Home, they are often the first line resource and support for individuals and their families. The Medical Home model encourages primary care providers to facilitate discussions on topics as varied as education and employment. Knowledge of specific medical issues unique to this population allows the primary care provider to complement the efforts of other specialty clinics and providers in often neglected areas such as sexual health, obesity and latex sensitization. As individuals with spina bifida live into adulthood, and access to traditional multidisciplinary care models evolves, these skills will take on increasing importance within the scope of providing comprehensive and coordinated care.

  7. Comparison of Goals of Care Between Hemodialysis Patients and Their Health Care Providers

    Directory of Open Access Journals (Sweden)

    Ariel Lefkowitz

    2016-11-01

    Full Text Available Background: Patient-centered care requires knowledge of patients’ goals of care (GoC on the part of health care providers (HCPs. Whether HCPs caring for in-center hemodialysis patients meet this criterion is uncertain. Objective: We designed and conducted a GoC survey among patients and HCPs within a single in-center hemodialysis (ICHD program to determine whether HCPs have an understanding of their patients’ GoC. Design: This was a prospective comparative quantitative survey study. Setting: The study included a single Canadian maintenance ICHD center. Participants: These included hemodialysis patients and their primary nephrologists, nurses, social workers, pharmacists, and dietitians. Methods and Measurements: Two surveys, one for patients and another for primary HCPs, were designed, piloted, and administered. For each participating patient, HCPs consisted of the primary nephrologist, nurse, social worker, pharmacist, and dietitian. Surveys included questions pertaining to 7 GoC themes. Patient-HCP agreement on the importance of each domain individually and the most important domain overall was assessed with kappa statistics. Factors influencing agreement were assessed with logistic regression in a secondary analysis. Results: A total of 173 patients were invited to participate, of whom 137 (79% completed surveys. Fifty HCPs completed 623 corresponding surveys: 132 by physicians, 112 by nurses, 126 by pharmacists, 127 by social workers, and 126 by dietitians. A total of 70.1% and 78.8% of patients agreed with the importance of and would feel comfortable having GoC discussions, respectively, with their HCPs; 42.7% of physicians reported not having provided prognostic information to the corresponding patient. Patient-HCP agreement regarding GoC was poor (all κ .05. In adjusted analyses, only patients choosing “Be Cured” as the most important GoC was significantly associated with poorer HCP-patient agreement than expected (odds ratio, 0

  8. The use of a Cumulative Needs for Care Monitor for individual treatment v. care as usual for patients diagnosed with severe mental illness, a cost-effectiveness analysis from the health care perspective

    NARCIS (Netherlands)

    Drukker, M.; Joore, M.; van Os, J.; Sytema, S.; Driessen, G.; Bak, M.; Delespaul, Ph.

    2012-01-01

    Aims. To study the systematic assessment of need for care and clinical parameters for use in treatment plans in patients diagnosed with severe mental illness. Methods. The Cumulative Needs for Care Monitor (CNCM) includes various validated instruments, such as the Camberwell Assessment of Need. A

  9. Effect of Offering Same-Day ART vs Usual Health Facility Referral During Home-Based HIV Testing on Linkage to Care and Viral Suppression Among Adults With HIV in Lesotho: The CASCADE Randomized Clinical Trial.

    Science.gov (United States)

    Labhardt, Niklaus D; Ringera, Isaac; Lejone, Thabo I; Klimkait, Thomas; Muhairwe, Josephine; Amstutz, Alain; Glass, Tracy R

    2018-03-20

    Home-based HIV testing is a frequently used strategy to increase awareness of HIV status in sub-Saharan Africa. However, with referral to health facilities, less than half of those who test HIV positive link to care and initiate antiretroviral therapy (ART). To determine whether offering same-day home-based ART to patients with HIV improves linkage to care and viral suppression in a rural, high-prevalence setting in sub-Saharan Africa. Open-label, 2-group, randomized clinical trial (February 22, 2016-September 17, 2017), involving 6 health care facilities in northern Lesotho. During home-based HIV testing in 6655 households from 60 rural villages and 17 urban areas, 278 individuals aged 18 years or older who tested HIV positive and were ART naive from 268 households consented and enrolled. Individuals from the same household were randomized into the same group. Participants were randomly assigned to be offered same-day home-based ART initiation (n = 138) and subsequent follow-up intervals of 1.5, 3, 6, 9, and 12 months after treatment initiation at the health facility or to receive usual care (n = 140) with referral to the nearest health facility for preparatory counseling followed by ART initiation and monthly follow-up visits thereafter. Primary end points were rates of linkage to care within 3 months (presenting at the health facility within 90 days after the home visit) and viral suppression at 12 months, defined as a viral load of less than 100 copies/mL from 11 through 14 months after enrollment. Among 278 randomized individuals (median age, 39 years [interquartile range, 28.0-52.0]; 180 women [65.7%]), 274 (98.6%) were included in the analysis (137 in the same-day group and 137 in the usual care group). In the same-day group, 134 (97.8%) indicated readiness to start ART that day and 2 (1.5%) within the next few days and were given a 1-month supply of ART. At 3 months, 68.6% (94) in same-day group vs 43.1% (59) in usual care group had linked to care

  10. Patients' perceptions of patient care providers with tattoos and/or body piercings.

    Science.gov (United States)

    Westerfield, Heather V; Stafford, Amy B; Speroni, Karen Gabel; Daniel, Marlon G

    2012-03-01

    This study evaluated patients' perceptions of patient care providers with visible tattoos and/or body piercings. As tattooing and body piercing are increasingly popular, research that informs nursing administrators regarding policies on patient care providers having visible tattoos and body piercings is warranted. A total of 150 hospitalized adult patients compared pictures of male and female patient care providers in uniform with and without tattoos and/or nonearlobe body piercings. Patient care providers with visible tattoos and/or body piercings were not perceived by patients in this study as more caring, confident, reliable, attentive, cooperative, professional, efficient, or approachable than nontattooed or nonpierced providers. Tattooed female providers were perceived as less professional than male providers with similar tattoos. Female providers with piercings were perceived as less confident, professional, efficient, and approachable than nonpierced female providers. Nursing administrators should develop and/or evaluate policies regarding patient care providers with visible tattoos and/or body piercings.

  11. Substitute Care Providers: Helping Abused and Neglected Children. The User Manual Series.

    Science.gov (United States)

    Watson, Kenneth

    This manual for child welfare staff and foster/adoptive parents is intended to provide guidelines for serving abused and neglected children who are in family foster care and adoption. The first section is on substitute care and permanency planning and offers an historical perspective on substitute care and definitions of family foster care and…

  12. Electronic cigarettes and thirdhand tobacco smoke: two emerging health care challenges for the primary care provider.

    Science.gov (United States)

    Kuschner, Ware G; Reddy, Sunayana; Mehrotra, Nidhi; Paintal, Harman S

    2011-02-01

    PRIMARY CARE PROVIDERS SHOULD BE AWARE OF TWO NEW DEVELOPMENTS IN NICOTINE ADDICTION AND SMOKING CESSATION: 1) the emergence of a novel nicotine delivery system known as the electronic (e-) cigarette; and 2) new reports of residual environmental nicotine and other biopersistent toxicants found in cigarette smoke, recently described as "thirdhand smoke". The purpose of this article is to provide a clinician-friendly introduction to these two emerging issues so that clinicians are well prepared to counsel smokers about newly recognized health concerns relevant to tobacco use. E-cigarettes are battery powered devices that convert nicotine into a vapor that can be inhaled. The World Health Organization has termed these devices electronic nicotine delivery systems (ENDS). The vapors from ENDS are complex mixtures of chemicals, not pure nicotine. It is unknown whether inhalation of the complex mixture of chemicals found in ENDS vapors is safe. There is no evidence that e-cigarettes are effective treatment for nicotine addiction. ENDS are not approved as smoking cessation devices. Primary care givers should anticipate being questioned by patients about the advisability of using e-cigarettes as a smoking cessation device. The term thirdhand smoke first appeared in the medical literature in 2009 when investigators introduced the term to describe residual tobacco smoke contamination that remains after the cigarette is extinguished. Thirdhand smoke is a hazardous exposure resulting from cigarette smoke residue that accumulates in cars, homes, and other indoor spaces. Tobacco-derived toxicants can react to form potent cancer causing compounds. Exposure to thirdhand smoke can occur through the skin, by breathing, and by ingestion long after smoke has cleared from a room. Counseling patients about the hazards of thirdhand smoke may provide additional motivation to quit smoking.

  13. The 2BFit study: is an unsupervised proprioceptive balance board training programme, given in addition to usual care, effective in preventing ankle sprain recurrences? Design of a Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    van Mechelen Willem

    2008-05-01

    Full Text Available Abstract Background There is strong evidence that athletes have a twofold risk for re-injury after a previous ankle sprain, especially during the first year post-injury. These ankle sprain recurrences could result in disability and lead to chronic pain or instability in 20 to 50% of these cases. When looking at the high rate of ankle sprain recurrences and the associated chronic results, ankle sprain recurrence prevention is important. Objective To evaluate the effect of a proprioceptive balance board training programme on ankle sprain recurrences, that was applied to individual athletes after rehabilitation and treatment by usual care. Methods/Design This study was designed as a randomized controlled trial with a follow-up of one year. Healthy individuals between 12 and 70 years of age, who were actively participating in sports and who had sustained a lateral ankle sprain up to two months prior to inclusion, were eligible for inclusion in the study. The intervention programme was compared to usual care. The intervention programme consisted of an eight-week proprioceptive training, which started after finishing usual care and from the moment that sports participation was again possible. Outcomes were assessed at baseline and every month for 12 months. The primary outcome of this study was the incidence of recurrent ankle injuries in both groups within one year after the initial sprain. Secondary outcomes were severity and etiology of re-injury and medical care. Cost-effectiveness was evaluated from a societal perspective. A process evaluation was conducted for the intervention programme. Discussion The 2BFit trial is the first randomized controlled trial to study the effect of a non-supervised home-based proprioceptive balance board training programme in addition to usual care, on the recurrence of ankle sprains in sports. Results of this study could possibly lead to changes in practical guidelines on the treatment of ankle sprains. Results will

  14. The effect of telehealth, telephone support or usual care on quality of life, mortality and healthcare utilization in elderly high-risk patients with multiple chronic conditions. A prospective study.

    Science.gov (United States)

    Valdivieso, Bernardo; García-Sempere, Anibal; Sanfélix-Gimeno, Gabriel; Faubel, Raquel; Librero, Julian; Soriano, Elisa; Peiró, Salvador

    2018-04-25

    To assess the effect of home based telehealth or structured telephone support interventions with respect to usual care on quality of life, mortality and healthcare utilization in elderly high-risk multiple chronic condition patients. 472 elderly high-risk patients with plurimorbidity in the region of Valencia (Spain) were recruited between June 2012 and May 2013, and followed for 12 months from recruitment. Patients were allocated to either: (a) a structured telephone intervention, a nurse-led case management program with telephone follow up every 15 days; (b) telehealth, which adds technology for remote self-management and the exchange of clinical data; or (c) usual care. Main outcome measures was quality of life measured by the EuroQol (EQ-5D) instrument, cognitive impairment, functional status, mortality and healthcare resource use. Inadequate randomization process led us to used propensity scores for adjusted analyses to control for imbalances between groups at baseline. EQ-5D score was significantly higher in the telehealth group compared to usual care (diff: 0.19, 0.08-0.30), but was not different to telephone support (diff: 0.04, -0.05 to 0.14). In adjusted analyses, inclusion in the telehealth group was associated with an additional 0.18 points in the EQ-5D score compared to usual care at 12 months (p<0.001), and with a gain of 0.13 points for the telephone support group (p<0.001). No differences in mortality or utilization were found, except for a borderline significant increase in General Practitioner visits. Telehealth was associated with better quality of life. Important limitations of the study and similarity of effects to telephone intervention call for careful endorsement of telemedicine. Clinicaltrials.gov (identifier: NCT02447562). Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

  15. Transcultural nursing: providing culturally congruent care to the Hausa of Northwest Africa.

    Science.gov (United States)

    Chmielarczyk, V

    1991-01-01

    Research around the world is now beginning to validate the theory of Cultural Care as an important means to provide culturally congruent care to clients, families, and groups of diverse cultures. Knowledge of Leininger's Theory of Cultural Care Diversity and Universality can provide meaningful care to clients who have different traditional and current beliefs and values. The Leininger Sunrise Model can serve as a valuable guide to discover care meanings and practices related to the theory, and to provide practical and meaningful culture specific care decisions and actions by nurses. The three major modes of action, namely, cultural care maintenance or preservation, accommodation or negotiation, and repatterning or restructuring, are important differential means to provide culturally congruent care to clients within their own cultural setting. This article considers the application of such care for the Hausa of Northwest Africa.(ABSTRACT TRUNCATED AT 250 WORDS)

  16. Barriers and Facilitators for the Implementation of an Online Clinical Health Community in Addition to Usual Fertility Care: A Cross-Sectional Study

    OpenAIRE

    Aarts, Johanna WM; Faber, Marjan J; den Boogert, Anne G; Cohlen, Ben J; van der Linden, Paul JQ; Kremer, Jan AM; Nelen, Willianne LDM

    2013-01-01

    BACKGROUND: Online health communities are becoming more popular in health care. Patients and professionals can communicate with one another online, patients can find peer support, and professionals can use it as an additional information channel to their patients. However, the implementation of online health communities into daily practice is challenging. These challenges relate to the fact that patients need to be activated to (1) become a member (ie, subscription) and (2) participate active...

  17. Electronic cigarettes and thirdhand tobacco smoke: two emerging health care challenges for the primary care provider

    Directory of Open Access Journals (Sweden)

    Nidhi Mehrotra

    2011-02-01

    Full Text Available Ware G Kuschner, Sunayana Reddy, Nidhi Mehrotra, Harman S PaintalDivision of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Palo Alto, CA, USAAbstract: Primary care providers should be aware of two new developments in nicotine addiction and smoking cessation: 1 the emergence of a novel nicotine delivery system known as the electronic (e- cigarette; and 2 new reports of residual environmental nicotine and other biopersistent toxicants found in cigarette smoke, recently described as “thirdhand smoke”. The purpose of this article is to provide a clinician-friendly introduction to these two emerging issues so that clinicians are well prepared to counsel smokers about newly recognized health concerns relevant to tobacco use. E-cigarettes are battery powered devices that convert nicotine into a vapor that can be inhaled. The World Health Organization has termed these devices electronic nicotine delivery systems (ENDS. The vapors from ENDS are complex mixtures of chemicals, not pure nicotine. It is unknown whether inhalation of the complex mixture of chemicals found in ENDS vapors is safe. There is no evidence that e-cigarettes are effective treatment for nicotine addiction. ENDS are not approved as smoking cessation devices. Primary care givers should anticipate being questioned by patients about the advisability of using e-cigarettes as a smoking cessation device. The term thirdhand smoke first appeared in the medical literature in 2009 when investigators introduced the term to describe residual tobacco smoke contamination that remains after the cigarette is extinguished. Thirdhand smoke is a hazardous exposure resulting from cigarette smoke residue that accumulates in cars, homes, and other indoor spaces. Tobacco-derived toxicants can react to form potent cancer causing compounds. Exposure to thirdhand smoke can occur through the skin, by breathing, and by ingestion long after smoke has cleared from a room

  18. More Than a "Number": Perspectives of Prenatal Care Quality from Mothers of Color and Providers.

    Science.gov (United States)

    Coley, Sheryl L; Zapata, Jasmine Y; Schwei, Rebecca J; Mihalovic, Glen Ellen; Matabele, Maya N; Jacobs, Elizabeth A; Anderson, Cynthie K

    African American mothers and other mothers of historically underserved populations consistently have higher rates of adverse birth outcomes than White mothers. Increasing prenatal care use among these mothers may reduce these disparities. Most prenatal care research focuses on prenatal care adequacy rather than concepts of quality. Even less research examines the dual perspectives of African American mothers and prenatal care providers. In this qualitative study, we compared perceptions of prenatal care quality between African American and mixed race mothers and prenatal care providers. Prenatal care providers (n = 20) and mothers who recently gave birth (n = 19) completed semistructured interviews. Using a thematic analysis approach and Donabedian's conceptual model of health care quality, interviews were analyzed to identify key themes and summarize differences in perspectives between providers and mothers. Mothers and providers valued the tailoring of care based on individual needs and functional patient-provider relationships as key elements of prenatal care quality. Providers acknowledged the need for knowing the social context of patients, but mothers and providers differed in perspectives of "culturally sensitive" prenatal care. Although most mothers had positive prenatal care experiences, mothers also recalled multiple complications with providers' negative assumptions and disregard for mothers' options in care. Exploring strategies to strengthen patient-provider interactions and communication during prenatal care visits remains critical to address for facilitating continuity of care for mothers of color. These findings warrant further investigation of dual patient and provider perspectives of culturally sensitive prenatal care to address the service needs of African American and mixed race mothers. Copyright © 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  19. Human trafficking: Role of oral health care providers.

    Science.gov (United States)

    Nuzzolese, E

    2014-11-30

    Trafficking in human beings is a modern form of slavery and is a well-known phenomenon throughout the European Union and beyond. After drug dealing and the weapons industry, human trafficking is the second largest criminal activity in the world today and it is a growing crime. The aim of governmental and non-governmental agencies, which are either directly or indirectly involved in combating trafficking in human beings, is the identification and referral of victims of trafficking and also to encourage self-referrals. Identification is the most important step to provide protection and assistance to victims of trafficking. Victims often have a variety of physical and mental health needs, including psychological trauma, injuries from violence, head and neck trauma, sexually transmitted infections and other gynaecological problems, dental/oral problems and have poor nutrition. The author's experience in the field of community dentistry in presented within. Volunteer dental services are offered to non-European Union patients held in a centre for asylum seekers in Bari (Italy). Dental professionals can, in fact, contribute to the identification, assistance and protection of trafficked persons, as well as offering forensic services to assist the police investigation in order to identify crimes and find the criminal organizations behind them. As for domestic violence and child abuse cases, there are ethical concerns involved in the identification and protection of the trafficked persons, as well as the need for interdisciplinary work and awareness. Adequate training in behavioural science and intercultural learning is paramount in order to avoid misunderstandings and increase sensitivity.

  20. Attitudes of Swiss Health Care Providers Toward Childhood Immunizations.

    Science.gov (United States)

    Schuler, Marianne; Schaedelin, Sabine; Aebi, Christoph; Berger, Christoph; Crisinel, Pierre-Alex; Diana, Alessandro; Niederer-Loher, Anita; Siegrist, Claire-Anne; Vaudaux, Bernard; Heininger, Ulrich

    2017-06-01

    INFOVAC is a network providing information about immunization issues to health professionals. The aim of this study was to assess the attitude of INFOVAC subscribers toward the current Swiss immunization schedule, potential modifications, and current and hypothetical immunization practices regarding their own children. In March 2015, a Web-based survey was sent to 4260 physicians and pharmacists subscribed to INFOVAC. Participation was anonymous and voluntary. The following information was obtained: (1) current immunization status of own children; (2) which immunizations would currently be accepted for a hypothetical own child and (3) attitudes toward potential modifications of the Swiss immunization schedule. Descriptive methods and multivariate models to correct for covariables were used for data analysis. Nine hundred and fifty-five valid questionnaires were received: 886/3704 (23.9%) from physicians and 69/556 (12.4%) from pharmacists. Current (>95%) and hypothetical (>99%) immunization rates were high for diphtheria, tetanus, pertussis, poliomyelitis and measles-mumps-rubella. Most pediatricians (61%) would support more vaccines for their children than currently recommended by the Swiss immunization advisory committee, whereas about 50% of other physicians and pharmacists would decline at least one of the recommended immunizations, most frequently varicella, pneumococcal or meningococcal C conjugate vaccines. Strong general support was expressed for the expansion of human papillomavirus immunization to males, acceleration of the measles-mumps-rubella schedule and a 2 + 1 instead of 3 + 1 diphtheria-tetanus-pertussis, acellular-inactivated poliomyelitis vaccine (DTPa-IPV)/Haemophilus influenzae type b ± hepatitis B virus (HBV) schedule. Survey participants generally demonstrated a positive attitude toward immunization, with pediatricians being the most progressive subgroup with the largest percentage of participants (63.1%) neither declining nor postponing any

  1. 76 FR 71920 - Payment for Home Health Services and Hospice Care by Non-VA Providers

    Science.gov (United States)

    2011-11-21

    ... concerning the billing methodology for non-VA providers of home health services and hospice care. The proposed rulemaking would include home health services and hospice care under the VA regulation governing... to ``RIN 2900-AN98--Payment for home health and services and hospice care by non-VA providers...

  2. 76 FR 51381 - Supplemental Awards to Seven Unaccompanied Alien Shelter Care Providers

    Science.gov (United States)

    2011-08-18

    ... Seven Unaccompanied Alien Shelter Care Providers AGENCY: Office of Refugee Resettlement, ACF, HHS... grants to seven Unaccompanied Alien Shelter Care Providers. CFDA Number: 93.676. Statutory Authority...) announces the award of single-source expansion supplement grants to seven unaccompanied alien shelter care...

  3. The Effectiveness of a Brief Asthma Education Intervention for Child Care Providers and Primary School Teachers

    Science.gov (United States)

    Neuharth-Pritchett, Stacey; Getch, Yvette Q.

    2016-01-01

    Limited information exists about management of asthma in child care settings and primary school classrooms. The goal of this study was to evaluate a brief asthma management intervention for child care providers and primary school teachers. Child care providers and primary school teachers were recruited to participate in two 3-h workshops on asthma…

  4. Sickness presenteeism among health care providers in an academic tertiary care center in Riyadh

    Directory of Open Access Journals (Sweden)

    Mohammed Al Nuhait

    2017-11-01

    Full Text Available The term sickness presenteeism (SP has been described as the act of going to work despite having a state of health that may be regarded as poor enough to justify sick leave. SP has been observed to be prevalent among three-quarters of health care providers (HCPs. Working while sick not only puts patients at risk but also decreases productivity and increases the probability of medical errors. Moreover, SP has been identified as a risk factor for many negative health outcomes among the HCPs themselves, such as depression, burnout, and serious cardiac events. The aim of this study was to identify the reasons for and prevalence of SP and perceptions of the impact of this practice on patient safety among HCPs. A cross-sectional study was conducted, including 279 purposively selected healthcare professionals (doctors, nurses, dentists, pharmacists and other health care professionals working at the Ministry of National Guard Health Affairs—King Abdulaziz Medical City (MNGHA-KAMC. While nearly all of the participants (91% believed that working while sick exposed patients to risk, the rate of SP during the past year was reported as 74%, and one fourth of respondents reported working while sick 3–4 times during the past year. More than half of the participants were not aware of the existence of a departmental policy regarding sick leave. The most common reasons reported for working while sick were not wanting to burden co-workers (71%, feelings of duty toward patients (67%, and avoiding an increased future workload caused by absence (59%. A lack of awareness regarding the existing rules and polices related to sick leave was reported by more than half of the participants. Several predisposing and enabling factors were reported as determinants influencing SP, e.g., observation of the practice of SP by peers and feelings of sympathy towards coworkers, including not wanting to overburden them, were reported to be determinants informing the decision of

  5. Economic evaluation of Internet-based problem-solving guided self-help treatment in comparison with enhanced usual care for depressed outpatients waiting for face-to-face treatment

    DEFF Research Database (Denmark)

    Kolovos, Spyros; Kenter, Robin M F; Bosmans, Judith E

    2016-01-01

    at outpatient clinics. METHODS: An economic evaluation was performed alongside a randomized controlled trial with 12 months follow-up. Outcomes were improvement in depressive symptom severity (measured by CES-D), response to treatment and Quality-Adjusted Life-Years (QALYs). Statistical uncertainty around cost......BACKGROUND: Previous studies have demonstrated the effectiveness of Internet-based interventions for depression in comparison with usual care. However, evidence on the cost-effectiveness of these interventions when delivered in outpatient clinics is lacking. The aim of this study was to estimate...... the cost-effectiveness of an Internet-based problem-solving guided self-help intervention in comparison with enhanced usual care for outpatients on a waiting list for face-to-face treatment for major depression. After the waiting list period, participants from both groups received the same treatment...

  6. The trajectory of experience of critical care nurses in providing end-of-life care: A qualitative descriptive study.

    Science.gov (United States)

    Ong, Keh Kiong; Ting, Kit Cheng; Chow, Yeow Leng

    2018-01-01

    To understand the perceptions of critical care nurses towards providing end-of-life care. There has been an increasing interest in end-of-life care in the critical care setting. In Singapore, approximately half of deaths in the hospital occur during critical care. While nurses are well positioned to provide end-of-life care to patients and their family members, they faced barriers to providing end-of-life care. Also, providing end-of-life care has profound positive and negative psychological effects on nurses, with the latter being more prominent. Qualitative descriptive design. Data collection was performed in a medical intensive care unit of a public tertiary hospital in Singapore. Ten registered nurses were purposively sampled and interviewed individually using a semi-structured interview guide. A codebook was developed to guide coding, and data were thematically analysed. Rigour was maintained. Nurses went through a trajectory of experience. They experienced the culture of care and developed dissatisfaction with it. The tension shaped their perception and meaning of life and death, and they developed mechanisms to reach resolution. This study provides insight on nurses' perception as a trajectory of experience and raised several implications on clinical practice, policy and research. There is a need to alleviate the tension nurses face and to facilitate coming to terms with the tension by improving the culture of care and supporting nurses. Nurses could be involved more in decision-making and empowered to start end-of-life care conversations within the team and with family members. Communication with family members and between nurses and doctors could be improved. Support for nurses providing end-of-life care could be enhanced through promoting social networks, education and bereavement support. Further research is needed to explore ways to support and empower nurses to provide end-of-life care in critical care. © 2017 John Wiley & Sons Ltd.

  7. The Work-Family Support Roles of Child Care Providers across Settings

    Science.gov (United States)

    Bromer, Juliet; Henly, Julia R.

    2009-01-01

    This paper presents a qualitative investigation of the work-family support roles of a sample of 29 child care providers serving low-income families in the Chicago area (16 family, friend, and neighbor providers (FFN), 7 licensed family child care providers (FCC), and 6 center-based teachers). Providers report offering low-income parents…

  8. My Daddy Takes Care of Me! Fathers as Care Providers. Current Population Reports. Household Economic Studies.

    Science.gov (United States)

    Casper, Lynne M.

    1997-01-01

    This report examines statistical data on fathers caring for their children during mothers' working hours and which types of fathers are the most likely to take care of their children. Data are taken from the Survey of Income and Program Participation, a longitudinal survey conducted at four-month intervals by the Census Bureau. Care by fathers is…

  9. Provider category and quality of care in the Norwegian nursing home industry

    Directory of Open Access Journals (Sweden)

    Astri Drange Hole

    2016-02-01

    Full Text Available This paper examines empirically if there is a link between quality of care in the Norwegian nursing home industry and exposure of the industry to competition. Exposing public care to competition implies that the responsibility for providing care services is shared between public authorities and private actors. In Norway, exposure to competition means tender competition. Suppliers bid for a contract issued by the Norwegian authorities for a limited number of years. Quality of care in an institution is the major competitive factor. The provider categories of elderly care are: 1 care provided by institutions run by municipalities, 2 care provided by institutions run by private companies, which have won a tender competition, 3 care provided by institutions run by private companies owned by private families, voluntary religious or idealistic organizations. Nurse-to-patient ratio is used as a proxy for quality of care. The regression analysis indicates a relationship between quality of care and exposure to competition. The quality of care in provider category 2 is significantly lower than in provider category 1, but there are more variations in the quality of care in provider category 1 than in provider category 2. We find the lowest quality of care in provider category 1. There is also a relationship between the quality of care in an institution and the educational level of the staff, the location, the workforce, and the size of an institution. Finally, there is a relationship between the quality of care in an institution and the real and the required capacity, and the financial status in a region.

  10. Self-Perceived End-of-Life Care Competencies of Health-Care Providers at a Large Academic Medical Center.

    Science.gov (United States)

    Montagnini, Marcos; Smith, Heather M; Price, Deborah M; Ghosh, Bidisha; Strodtman, Linda

    2018-01-01

    In the United States, most deaths occur in hospitals, with approximately 25% of hospitalized patients having palliative care needs. Therefore, the provision of good end-of-life (EOL) care to these patients is a priority. However, research assessing staff preparedness for the provision of EOL care to hospitalized patients is lacking. To assess health-care professionals' self-perceived competencies regarding the provision of EOL care in hospitalized patients. Descriptive study of self-perceived EOL care competencies among health-care professionals. The study instrument (End-of-Life Questionnaire) contains 28 questions assessing knowledge, attitudes, and behaviors related to the provision of EOL care. Health-care professionals (nursing, medicine, social work, psychology, physical, occupational and respiratory therapist, and spiritual care) at a large academic medical center participated in the study. Means were calculated for each item, and comparisons of mean scores were conducted via t tests. Analysis of variance was used to identify differences among groups. A total of 1197 questionnaires was completed. The greatest self-perceived competency was in providing emotional support for patients/families, and the least self-perceived competency was in providing continuity of care. When compared to nurses, physicians had higher scores on EOL care attitudes, behaviors, and communication. Physicians and nurses had higher scores on most subscales than other health-care providers. Differences in self-perceived EOL care competencies were identified among disciplines, particularly between physicians and nurses. The results provide evidence for assessing health-care providers to identify their specific training needs before implementing educational programs on EOL care.

  11. Perceptions of informal care givers: health and support services provided to people with multiple sclerosis.

    Science.gov (United States)

    Buchanan, Robert; Radin, Dagmar; Chakravorty, Bonnie J; Tyry, Tuula

    2010-01-01

    About 30% of people with multiple sclerosis (MS) need some form of home care assistance, with 80% of that assistance provided by informal or unpaid care givers. This study focuses on the care givers to 530 more disabled people with MS, with the objective to learn more about informal care giving to people with greater dependency and need for assistance. The data presented in this study were collected in a national survey of 530 informal care givers to people with MS who have greater levels of physical dependency. About 70% of informal care givers responded that assisting the person with MS perform daily activities or personal care took up the largest amount of their care giving time. Care givers also reported a range of home and community-based services that would make care giving easier or improve the care provided. However, informal care givers generally reported low satisfaction with health insurance coverage of these services, especially coverage by health maintenance organizations and other managed care plans. Lack of health insurance coverage of needed home and community-based services can reduce the quality of informal care provided, as well as increase the burden of informal care giving.

  12. Realising participation within an action research project on two Care Innovation Units providing care for older people.

    NARCIS (Netherlands)

    Drs Miranda Snoeren; MSc Donna Frost

    2011-01-01

    Background: On two Care Innovation Units in the Netherlands, staff, students and Lecturer Practitioners work intensively together to provide care, create a rich learning environment, and to foster innovation and research. In striving to advance the quality of care and to develop person centred

  13. The Effect of Group Discussion-based Education on Self-management of Adults with Type 2 Diabetes Mellitus Compared with Usual Care: A Randomized Control Trial.

    Science.gov (United States)

    Habibzadeh, Hosein; Sofiani, Akbar; Alilu, Leyla; Gillespie, Mark

    2017-11-01

    We sought to determine the effect of group discussion-based education on the self-management capability of patients with type 2 diabetes in Iran. This randomized control trial was conducted on 90 patients with type 2 diabetes. Participants were allocated randomly into one of two groups; intervention and control. The intervention group received the group discussion-based education while the control group received routine care only. The Lin's self-management questionnaire was completed at baseline and three months post-intervention. Statistical analysis, including the use of independent t -test, identified that in comparison to the control group, significant increases were observed in the scores of self-organization ( t =11.24, p health experts ( t = 7.31, p diet ( t = 5.22, p diabetes.

  14. Workers' opinions on the effect of contact with health care providers on sickness absence duration.

    Science.gov (United States)

    Steenbeek, Romy

    2014-01-01

    Because of the aging working population and the increasing age of retirement the number of workers with chronic illnesses and disabilities is growing. It is important that workers with health complaints receive efficient health care in order to remain fully or at least partly productive. To explore workers' opinions about the effectiveness of contact with health care providers in shortening sickness absence duration. Data come from a four-wave study from 2005 to 2008 among Dutch workers (n=1,424). Data were obtained on visits to health care providers, sickness absence and workers' opinions on whether and how their absence could have been shortened. A third of the workers were of the opinion that the health care provider (most often the general practitioner, GP) had played a role in preventing sickness absence and 35% were of the opinion that the health care provider had limited their absence. Most often the physical therapist (71%) and mental health therapist (61%) shortened sickness absence duration, in contrast to the occupational physician (OP, 25%) and GP (32%). The effectiveness of the health care providers' treatment was associated with the cause of sickness absence. Approximately 15% of the workers reported that their sickness absence could have been shortened if health care providers had provided the proper treatment and if waiting times had been reduced. Health care providers differ in their potential to shorten sickness absence duration. Health care providers can further reduce sickness absence and health care costs by providing the proper treatment and by reducing waiting times.

  15. Current practice of usual clinic blood pressure measurement in people with and without diabetes: a survey and prospective 'mystery shopper' study in UK primary care.

    Science.gov (United States)

    Stevens, Sarah L; McManus, Richard J; Stevens, Richard John

    2018-04-12

    Hypertension trials and epidemiological studies use multiple clinic blood pressure (BP) measurements at each visit. Repeat measurement is also recommended in international guidance; however, little is known about how BP is measured routinely. This is important for individual patient management and because routinely recorded readings form part of research databases. We aimed to determine the current practice of BP measurement during routine general practice appointments. (1) An online cross-sectional survey and (2) a prospective 'mystery shopper' study where patients agreed to report how BP was measured during their next appointment. Primary care. Patient charity/involvement group members completing an online survey between July 2015 and January 2016. 334 participants completed the prospective study (51.5% male, mean age=59.3 years) of which 279 (83.5%) had diabetes. Proportion of patients having BP measured according to guidelines. 217 participants with (183) and without diabetes (34) had their BP measured at their last appointment. BP was measured in line with UK guidance in 63.7% and 60.0% of participants with and without diabetes, respectively. Initial pressures were significantly higher in those who had their BP measured more than once compared with only once (p=0.016/0.089 systolic and p<0.001/p=0.022 diastolic, in patients with/without diabetes, respectively). Current practice of routine BP measurement in UK primary care is often concordant with guidelines for repeat measurement. Further studies are required to confirm findings in broader populations, to confirm when a third repeat reading is obtained routinely and to assess adherence to other aspects of BP measurement guidance. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  16. Health care access and quality for persons with disability: Patient and provider recommendations.

    Science.gov (United States)

    McClintock, Heather F; Kurichi, Jibby E; Barg, Frances K; Krueger, Alice; Colletti, Patrice M; Wearing, Krizia A; Bogner, Hillary R

    2018-07-01

    Significant disparities in health care access and quality persist between persons with disabilities (PWD) and persons without disabilities (PWOD). Little research has examined recommendations of patients and providers to improve health care for PWD. We sought to explore patient and health care provider recommendations to improve health care access and quality for PWD through focus groups in the physical world in a community center and in the virtual world in an online community. In all, 17 PWD, 4 PWOD, and 6 health care providers participated in 1 of 5 focus groups. Focus groups were conducted in the virtual world in Second Life ® with Virtual Ability, an online community, and in the physical world at Agape Community Center in Milwaukee, WI. Focus group data were analyzed using a grounded theory methodology. Themes that emerged in focus groups among PWD and PWOD as well as health care providers to improve health care access and quality for PWD were: promoting advocacy, increasing awareness and knowledge, improving communication, addressing assumptions, as well as modifying and creating policy. Many participants discussed political empowerment and engagement as central to health care reform. Both PWD and PWOD as well as health care providers identified common themes potentially important for improving health care for PWD. Patient and health care provider recommendations highlight a need for modification of current paradigms, practices, and approaches to improve the quality of health care provision for PWD. Participants emphasized the need for greater advocacy and political engagement. Copyright © 2018 Elsevier Inc. All rights reserved.

  17. The limits of market-based reforms in the NHS: the case of alternative providers in primary care.

    Science.gov (United States)

    Coleman, Anna; Checkland, Kath; McDermott, Imelda; Harrison, Stephen

    2013-01-01

    Historically, primary medical care in the UK has been delivered by general practitioners who are independent contractors, operating under a contract, which until 2004 was subject to little performance management. In keeping with the wider political impetus to introduce markets and competition into the NHS, reforms were introduced to allow new providers to bid for contracts to provide primary care services in England. These contracts known as 'Alternative Provider Medical Services', were encouraged by two centrally-driven rounds of procurement (2007/8 and 2008/9). This research investigated the commissioning and operation of such Alternative Providers of Primary Care (APPCs). Two qualitative case studies were undertaken in purposively sampled English Primary Care Trusts (PCTs) and their associated APPCs over 14 months (2009-10). We observed 65 hours of meetings, conducted 23 interviews with PCT and practice staff, and gathered relevant associated documentation. We found that the procurement and contracting process was costly and time-consuming. Extensive local consultation was undertaken, and there was considerable opposition in some areas. Many APPCs struggled to build up their patient list sizes, whilst over-performing on walk-in contracts. Contracting for APPCs was 'transactional', in marked contrast to the 'relational' contracting usually found in the NHS, with APPCs subject to tight performance management. These complicated and costly processes contrast to those experienced by traditionally owned GP partnerships. However, managers reported that the perception of competition had led existing practices to improve their services. The Coalition Government elected in 2010 is committed to 'Any Qualified Provider' of secondary care, and some commentators argue that this should also be applied to primary care. Our research suggests that, if this is to happen, a debate is needed about the operation of a market in primary care provision, including the trade-offs between

  18. Testing the effectiveness of a motivational interviewing-based brief intervention for substance use as an adjunct to usual care in community-based AIDS service organizations: study protocol for a multisite randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Bryan R. Garner

    2017-11-01

    Full Text Available Abstract Background In 2010, the first comprehensive National HIV/AIDS Strategy for the United States was released and included three goals: (1 reducing the number of people who become infected with HIV, (2 increasing access to care and improving health outcomes for people living with HIV, and (3 reducing HIV-related health disparities and health inequities. In 2013, as part of its effort to help address the National HIV/AIDS Strategy, the National Institute on Drug Abuse (NIDA funded a type 2 effectiveness-implementation hybrid trial titled the Substance Abuse Treatment to HIV Care (SAT2HIV Project. Aim 1 of the SAT2HIV Project tests the effectiveness of a motivational interviewing-based brief intervention (MIBI for substance use as an adjunct to usual care within AIDS Service Organizations (ASOs as part of its MIBI Experiment. Aim 2 of the SAT2HIV Project tests the effectiveness of implementation and sustainment facilitation (ISF as an adjunct to the Addiction Technology Transfer Center (ATTC model for training staff in motivational interviewing as part of its ISF Experiment. The current paper describes the study protocol for the ISF Experiment. Methods As part of a multisite randomized controlled trial, individuals with comorbid HIV/AIDS and problematic substance use are randomized to receive either the ASOs’ usual care (control condition or usual care plus a MIBI for substance use (experimental condition delivered by trained ASO case-management staff. Primary outcome measures are reductions in days of primary substance use, number of substance-related problems, times engaging in risky behaviors, days of non-adherence to HIV medications, and increases in substance use treatment. As part of this paper, we describe the trial protocol in accordance with the Standard Protocol Items: Recommendations for Interventional Trials guidelines. Discussion If successfully able to implement MIBI as an effective adjunct to usual care, the current trial may

  19. The Effect of Group Discussion-based Education on Self-management of Adults with Type 2 Diabetes Mellitus Compared with Usual Care: A Randomized Control Trial

    Directory of Open Access Journals (Sweden)

    Hosein Habibzadeh

    2017-11-01

    Full Text Available Objectives: We sought to determine the effect of group discussion-based education on the self-management capability of patients with type 2 diabetes in Iran. Methods: This randomized control trial was conducted on 90 patients with type 2 diabetes. Participants were allocated randomly into one of two groups; intervention and control. The intervention group received the group discussion-based education while the control group received routine care only. The Lin’s self-management questionnaire was completed at baseline and three months post-intervention. Results: Statistical analysis, including the use of independent t-test, identified that in comparison to the control group, significant increases were observed in the scores of self-organization (t =11.24, p < 0.001, self-adjustment (t = 7.53, p < 0.001, interaction with health experts (t = 7.31, p < 0.001, blood sugar self-monitoring (t = 6.42, p < 0.001, adherence to the proposed diet (t = 5.22, p < 0.001, and total self-management (t = 10.82, p < 0.001 in the intervention group. Conclusions: Sharing experiences through group discussions and receiving instructive feedback can improve the ability to self-manage diabetes.

  20. Observations of oral hygiene care interventions provided by nurses to hospitalized older people.

    Science.gov (United States)

    Coker, Esther; Ploeg, Jenny; Kaasalainen, Sharon; Carter, Nancy

    Dependent older hospitalized patients rely on nurses to assist them with the removal of plaque from their teeth, dentures, and oral cavities. Oral care interventions by 25 nurses on post-acute units, where patients have longer hospital stays, were observed during evening care. In addition to efforts to engage patients in oral care, nurses provided the following interventions: (a) supporting the care of persons with dentures; (b) supporting the care of natural teeth; (c) cleansing the tongue and oral cavity; and (d) moisturizing lips and oral tissues. Patients' oral hygiene care was supported in just over one-third of encounters. Denture care was inconsistently performed, and was infrequently followed by care of the oral cavity. Nurses did not encourage adequate self-care of natural teeth by patients, and infrequently moisturized tissues. Evidence-based oral hygiene care standards are required to assist nurses to support patients in achieving optimal oral hygiene outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Faster return to work after psychiatric consultation for sicklisted employees with common mental disorders compared to care as usual. A randomized clinical trial

    NARCIS (Netherlands)

    van der Feltz-Cornelis, Christina M.; Hoedeman, Rob; de Jong, Fransina J.; Meeuwissen, Jolanda A. C.; Drewes, Hanneke W.; van der Laan, Niels C.; Ader, Herman J.

    2010-01-01

    Introduction: Return to work (RTW) of employees on sick leave for common mental disorders may require a multidisciplinary approach. This article aims to assess time to RTW after a psychiatric consultation providing treatment advice to the occupational physician (OP) for employees on sick leave for

  2. [Communication strategies used by health care professionals in providing palliative care to patients].

    Science.gov (United States)

    Trovo de Araújo, Monica Martins; da Silva, Maria Júlia Paes

    2012-06-01

    The objective of this study is to verify the relevance and utilization of communication strategies in palliative care. This is a multicenter qualitative study using a questionnaire, performed from August of 2008 to July of 2009 with 303 health care professionals who worked with patients receiving palliative care. Data were subjected to descriptive statistical analysis. Most participants (57.7%) were unable to state at least one verbal communication strategy, and only 15.2% were able to describe five signs or non-verbal communication strategies. The verbal strategies most commonly mentioned were those related to answering questions about the disease/treatment. Among the non-verbal strategies used, the most common were affective touch, looking, smiling, physical proximity, and careful listening. Though professionals have assigned a high degree of importance to communication in palliative care, they showed poor knowledge regarding communication strategies. Final considerations include the necessity of training professionals to communicate effectively in palliative care.

  3. Just-in-time consent: The ethical case for an alternative to traditional informed consent in randomized trials comparing an experimental intervention with usual care.

    Science.gov (United States)

    Vickers, Andrew J; Young-Afat, Danny A; Ehdaie, Behfar; Kim, Scott Yh

    2018-02-01

    Informed consent for randomized trials often causes significant and persistent anxiety, distress and confusion to patients. Where an experimental treatment is compared to a standard care control, much of this burden is potentially avoidable in the control group. We propose a "just-in-time" consent in which consent discussions take place in two stages: an initial consent to research from all participants and a later specific consent to randomized treatment only from those assigned to the experimental intervention. All patients are first approached and informed about research procedures, such as questionnaires or tests. They are also informed that they might be randomly selected to receive an experimental treatment and that, if selected, they can learn more about the treatment and decide whether or not to accept it at that time. After randomization, control patients undergo standard clinical consent whereas patients randomized to the experimental procedure undergo a second consent discussion. Analysis would be by intent-to-treat, which protects the trial from selection bias, although not from poor acceptance of experimental treatment. The advantages of just-in-time consent stem from the fact that only patients randomized to the experimental treatment are subject to a discussion of that intervention. We hypothesize that this will reduce much of the patient's burden associated with the consent process, such as decisional anxiety, confusion and information overload. We recommend well-controlled studies to compare just-in-time and traditional consent, with endpoints to include characteristics of participants, distress and anxiety and participants' understanding of research procedures.

  4. Determinants of patient choice of health care providers: a scoping review.

    NARCIS (Netherlands)

    Victoor, A.; Delnoij, D.M.J.; Friele, R.D.; Rademakers, J.J.D.J.M.

    2012-01-01

    Background: In several North-Western European countries, a demand driven health care system has been implemented that stresses the importance of patient choice of health care providers. Patients are assumed to actively choose the best provider with the lowest costs. This selection prompts providers

  5. Critical Care

    Science.gov (United States)

    Critical care helps people with life-threatening injuries and illnesses. It might treat problems such as complications from surgery, ... attention by a team of specially-trained health care providers. Critical care usually takes place in an ...

  6. Does patient-provider gender concordance affect mental health care received by primary care patients with major depression?

    Science.gov (United States)

    Chan, Kitty S; Bird, Chloe E; Weiss, Robert; Duan, Naihua; Meredith, Lisa S; Sherbourne, Cathy D

    2006-01-01

    We sought to determine whether patient-provider gender concordance influences the detection and care of depression and comorbid anxiety and substance use in patients with major depression Cross-sectional analyses of baseline patient survey data linked with provider data were performed. Data based on routine primary care visits in clinics from a variety of health systems serving diverse patient populations across the United States. Participants all had major depression. Depression care was examined in the Quality Improvement for Depression (QID) Collaboration sample (n patients = 1,428, n providers = 389). In a subanalysis of data solely from 714 patients and 157 providers from Partners-In-Care, one of the projects participating in QID, we also examined detection of anxiety disorder and alcohol or drug problems. Rates of detection and care of mental health problems in primary care were low even among patients with major depression. Except for anxiety counseling in female patients, patient-provider gender concordance did not improve care as hypothesized. However, female providers were more likely to counsel on anxiety and less likely to counsel on alcohol or drug use than male providers. Female patients were less likely to be counseled on alcohol or drug use compared with male patients. Detection and care of mental health and substance use problems for patients with major depression is not influenced by patient-provider gender concordance. However, depressed female patients may have greater unmet needs for alcohol and drug use counseling than their male counterparts.

  7. Complementary and conventional providers in cancer care: experience of communication with patients and steps to improve communication with other providers.

    Science.gov (United States)

    Stub, Trine; Quandt, Sara A; Arcury, Thomas A; Sandberg, Joanne C; Kristoffersen, Agnete E

    2017-06-08

    Effective interdisciplinary communication is important to achieve better quality in health care. The aims of this study were to compare conventional and complementary providers' experience of communication about complementary therapies and conventional medicine with their cancer patients, and to investigate how they experience interdisciplinary communication and cooperation. This study analyzed data from a self-administrated questionnaire. A total of 606 different health care providers, from four counties in Norway, completed the questionnaire. The survey was developed to describe aspects of the communication pattern among oncology doctors, nurses, family physicians and complementary therapists (acupuncturists, massage therapists and reflexologists/zone-therapists). Between-group differences were analyzed using chi-square, ANOVA and Fisher's exact tests. Significance level was defined as p communication with their cancer patients regarding complementary therapies. While complementary therapists advised their patients to apply both complementary and conventional modalities, medical doctors were less supportive of their patients' use of complementary therapies. Of conventional providers, nurses expressed more positive attitudes toward complementary therapies. Opportunities to improve communication between conventional and complementary providers were most strongly supported by complementary providers and nurses; medical doctors were less supportive of such attempts. A number of doctors showed lack of respect for complementary therapists, but asked for more research, guidelines for complementary modalities and training in conventional medicine for complementary therapists. For better quality of care, greater communication about complementary therapy use is needed between cancer patients and their conventional and complementary providers. In addition, more communication between conventional and complementary providers is needed. Nurses may have a crucial role in

  8. The limits of market-based reforms in the NHS: the case of alternative providers in primary care

    Science.gov (United States)

    2013-01-01

    Background Historically, primary medical care in the UK has been delivered by general practitioners who are independent contractors, operating under a contract, which until 2004 was subject to little performance management. In keeping with the wider political impetus to introduce markets and competition into the NHS, reforms were introduced to allow new providers to bid for contracts to provide primary care services in England. These contracts known as ‘Alternative Provider Medical Services’, were encouraged by two centrally-driven rounds of procurement (2007/8 and 2008/9). This research investigated the commissioning and operation of such Alternative Providers of Primary Care (APPCs). Methods Two qualitative case studies were undertaken in purposively sampled English Primary Care Trusts (PCTs) and their associated APPCs over 14 months (2009-10). We observed 65 hours of meetings, conducted 23 interviews with PCT and practice staff, and gathered relevant associated documentation. Results and conclusions We found that the procurement and contracting process was costly and time-consuming. Extensive local consultation was undertaken, and there was considerable opposition in some areas. Many APPCs struggled to build up their patient list sizes, whilst over-performing on walk-in contracts. Contracting for APPCs was ‘transactional’, in marked contrast to the ‘relational’ contracting usually found in the NHS, with APPCs subject to tight performance management. These complicated and costly processes contrast to those experienced by traditionally owned GP partnerships. However, managers reported that the perception of competition had led existing practices to improve their services. The Coalition Government elected in 2010 is committed to ‘Any Qualified Provider’ of secondary care, and some commentators argue that this should also be applied to primary care. Our research suggests that, if this is to happen, a debate is needed about the operation of a market

  9. Rates of detection of developmental problems at the 18-month well-baby visit by family physicians' using four evidence-based screening tools compared to usual care: a randomized controlled trial.

    Science.gov (United States)

    Thomas, R E; Spragins, W; Mazloum, G; Cronkhite, M; Maru, G

    2016-05-01

    Early and regular developmental screening can improve children's development through early intervention but is insufficiently used. Most developmental problems are readily evident at the 18-month well-baby visit. This trial's purpose is to: (1) compare identification rates of developmental problems by GPs/family physicians using four evidence-based tools with non-evidence based screening, and (2) ascertain whether the four tools can be completed in 10-min pre-visit on a computer. We compared two approaches to early identification via random assignment of 54 families to either: 'usual care' (informal judgment including ad-hoc milestones, n = 25); or (2) 'Evidence-based' care (use of four validated, accurate screening tools, n = 29), including: the Parents' Evaluation of Developmental Status (PEDS), the PEDS-Developmental Milestones (PEDS-DM), the Modified Checklist for Autism in Toddlers (M-CHAT) and PHQ9 (maternal depression). In the 'usual care' group four (16%) and in the evidence-based tools group 18 (62%) were identified as having a possible developmental problem. In the evidence-based tools group three infants were to be recalled at 24 months for language checks (no specialist referrals made). In the 'usual care' group four problems were identified: one child was referred for speech therapy, two to return to check language at 24 months and a mother to discuss depression. All forms were completed on-line within 10 min. Despite higher early detection rates in the evidence-based care group, there were no differences in referral rates between evidence-based and usual-care groups. This suggests that clinicians: (1) override evidence-based screening results with informal judgment; and/or (2) need assistance understanding test results and making referrals. Possible solutions are improve the quality of information obtained from the screening process, improved training of physicians, improved support for individual practices and acceptance by the regional

  10. A comparative consecutive case series of 20 children with a diagnosis of ADHD receiving homeopathic treatment, compared with 10 children receiving usual care.

    Science.gov (United States)

    Fibert, Philippa; Relton, Clare; Heirs, Morag; Bowden, Deborah

    2016-05-01

    methodically rigorous research is warranted. "We recommend that future research in this area uses comparative effectiveness randomised controlled trial designs. We also recommend that these trials measure outcomes of relevance to stakeholder needs - the people and services who care for those with ADHD - parents, teachers and social workers and the criminal justice system". Copyright © 2015 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved.

  11. Mapping a Research Agenda for Home Care Safety: Perspectives from Researchers, Providers, and Decision Makers

    Science.gov (United States)

    Macdonald, Marilyn; Lang, Ariella; MacDonald, Jo-Anne

    2011-01-01

    The purpose of this qualitative interpretive design was to explore the perspectives of researchers, health care providers, policy makers, and decision makers on key risks, concerns, and emerging issues related to home care safety that would inform a line of research inquiry. Defining safety specifically in this home care context has yet to be…

  12. Psychosocial Influences upon the Workforce and Professional Development Participation of Family Child Care Providers

    Science.gov (United States)

    Swartz, Rebecca Anne; Wiley, Angela R.; A. Koziol, Natalie; Magerko, Katherine A.

    2016-01-01

    Background: Family child care is commonly used in the US by families, including by those receiving child care subsidies. Psychosocial influences upon the workforce and professional development participation of family child care providers (FCCPs) have implications for the investment of public dollars that aim to improve quality and stability of…

  13. The Impact of the Professional Qualifications of the Prenatal Care Provider on Breastfeeding Duration.

    Science.gov (United States)

    Wallenborn, Jordyn T; Lu, Juan; Perera, Robert A; Wheeler, David C; Masho, Saba W

    2018-03-01

    A prenatal commitment to breastfeed is a strong predictor for breastfeeding success. Prenatal care providers have the opportunity to educate and promote breastfeeding. However, differences in education and training between healthcare providers such as physicians and midwives may result in differing breastfeeding outcomes. This study explores whether breastfeeding initiation and duration differ by prenatal care provider. Longitudinal data from the Infant Feeding Practices Survey II were analyzed (N = 2,832 women). Prenatal care providers were categorized as obstetrician, family/other physician, and midwife/nurse-midwife. Breastfeeding initiation was dichotomized (yes; no). Breastfeeding duration and exclusive breastfeeding duration were reported in weeks. Logistic regression was used to investigate the relationship between prenatal care provider and breastfeeding initiation. Cox proportional hazard models provided crude and adjusted hazard ratios and 95% confidence limits to determine the relationship between type of prenatal care provider and breastfeeding duration. After adjusting for confounders, women who received care from a midwife were 68% less likely to never breastfed than women whose prenatal care was provided by an obstetrician. Women whose prenatal care was provided by a midwife had 14% lower risk of discontinuing breastfeeding and 23% lower risk of discontinuing exclusive breastfeeding. No significant association was found between women whose prenatal care was provided by a family physician or other type of physician and breastfeeding initiation and duration. Findings highlight the importance of prenatal care providers on breastfeeding duration. Future studies should examine factors (i.e., training, patient-provider interaction) that contribute to differences in breastfeeding outcomes by type of prenatal care provider.

  14. Sickness presenteeism among health care providers in an academic tertiary care center in Riyadh.

    Science.gov (United States)

    Al Nuhait, Mohammed; Al Harbi, Khaled; Al Jarboa, Amjad; Bustami, Rami; Alharbi, Shmaylan; Masud, Nazish; Albekairy, Abdulkareem; Almodaimegh, Hind

    The term sickness presenteeism (SP) has been described as the act of going to work despite having a state of health that may be regarded as poor enough to justify sick leave. SP has been observed to be prevalent among three-quarters of health care providers (HCPs). Working while sick not only puts patients at risk but also decreases productivity and increases the probability of medical errors. Moreover, SP has been identified as a risk factor for many negative health outcomes among the HCPs themselves, such as depression, burnout, and serious cardiac events. The aim of this study was to identify the reasons for and prevalence of SP and perceptions of the impact of this practice on patient safety among HCPs. A cross-sectional study was conducted, including 279 purposively selected healthcare professionals (doctors, nurses, dentists, pharmacists and other health care professionals) working at the Ministry of National Guard Health Affairs-King Abdulaziz Medical City (MNGHA-KAMC). While nearly all of the participants (91%) believed that working while sick exposed patients to risk, the rate of SP during the past year was reported as 74%, and one fourth of respondents reported working while sick 3-4 times during the past year. More than half of the participants were not aware of the existence of a departmental policy regarding sick leave. The most common reasons reported for working while sick were not wanting to burden co-workers (71%), feelings of duty toward patients (67%), and avoiding an increased future workload caused by absence (59%). A lack of awareness regarding the existing rules and polices related to sick leave was reported by more than half of the participants. Several predisposing and enabling factors were reported as determinants influencing SP, e.g., observation of the practice of SP by peers and feelings of sympathy towards coworkers, including not wanting to overburden them, were reported to be determinants informing the decision of whether to work

  15. Improving health care strategy planning through assessment of perceptions of consumers, providers and administrators.

    Science.gov (United States)

    Scammon, D; Kennard, L

    1983-01-01

    Perceptions of consumers, health care administrators, and physicians regarding health care providers are analyzed. Ratings on 26 dimensions of health care services were obtained from members of the three participant groups using measures of image and satisfaction of both physicians in general, and of specific physicians. Discriminant analysis reveals significantly different perceptions of the health care system among the three groups of respondents. These differences suggest some changes in health care administration which could lead to increased consumer satisfaction and competitive advantages for physicians and health care institutions.

  16. Implementation of client versus care-provider strategies to improve external cephalic version rates: a cluster randomized controlled trial.

    Science.gov (United States)

    Vlemmix, Floortje; Rosman, Ageeth N; Rijnders, Marlies E; Beuckens, Antje; Opmeer, Brent C; Mol, Ben W J; Kok, Marjolein; Fleuren, Margot A H

    2015-05-01

    To determine the effectiveness of a client or care-provider strategy to improve the implementation of external cephalic version. Cluster randomized controlled trial. Twenty-five clusters; hospitals and their referring midwifery practices randomly selected in the Netherlands. Singleton breech presentation from 32 weeks of gestation onwards. We randomized clusters to a client strategy (written information leaflets and decision aid), a care-provider strategy (1-day counseling course focused on knowledge and counseling skills), a combined client and care-provider strategy and care-as-usual strategy. We performed an intention-to-treat analysis. Rate of external cephalic version in various strategies. Secondary outcomes were the percentage of women counseled and opting for a version attempt. The overall implementation rate of external cephalic version was 72% (1169 of 1613 eligible clients) with a range between clusters of 8-95%. Neither the client strategy (OR 0.8, 95% CI 0.4-1.5) nor the care-provider strategy (OR 1.2, 95% CI 0.6-2.3) showed significant improvements. Results were comparable when we limited the analysis to those women who were actually offered intervention (OR 0.6, 95% CI 0.3-1.4 and OR 2.0, 95% CI 0.7-4.5). Neither a client nor a care-provider strategy improved the external cephalic version implementation rate for breech presentation, neither with regard to the number of version attempts offered nor the number of women accepting the procedure. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

  17. The epidemiology of skin care provided by nurses at home: a multicentre prevalence study.

    Science.gov (United States)

    Kottner, Jan; Boronat, Xavier; Blume-Peytavi, Ulrike; Lahmann, Nils; Suhr, Ralf

    2015-03-01

    The aim of this study was to estimate the frequencies and patterns of skin care and applied skin care products in the home care nursing setting in Germany. Skin care belongs to the core activities of nursing practice. Especially in aged and long-term care settings, clients are vulnerable to various skin conditions. Dry skin is one of the most prevalent problems. Using mild skin cleansers and the regular application of moisturizing leave-on products is recommended. Until today, there are no quantitative empirical data about nursing skin care practice at home in the community. A multicentre cross-sectional study was conducted in July 2012. Home care clients from the German home care nursing setting were randomly selected. Instructed nurse raters performed the data collection using standardized forms. Variables included demographics, skin care needs and skin caring activities. Approximately 60% of home care clients received skin care interventions. The majority were washed and two-thirds received a leave-on product once daily. There was large heterogeneity in cleansing and skin care product use. Most often the product labels were unknown or product types were selected haphazardly. Skin care interventions play a significant role in home care and nurses have a considerable responsibility for skin health. Skin care provided does not meet recent recommendations. The importance of targeted skin cleansing and care might be underestimated. There are a confusing variety of skin care products available and often the labels provide little information regarding the ingredients or guidance about how they affect skin health. © 2014 John Wiley & Sons Ltd.

  18. An agent-based simulation model of patient choice of health care providers in accountable care organizations.

    Science.gov (United States)

    Alibrahim, Abdullah; Wu, Shinyi

    2018-03-01

    Accountable care organizations (ACO) in the United States show promise in controlling health care costs while preserving patients' choice of providers. Understanding the effects of patient choice is critical in novel payment and delivery models like ACO that depend on continuity of care and accountability. The financial, utilization, and behavioral implications associated with a patient's decision to forego local health care providers for more distant ones to access higher quality care remain unknown. To study this question, we used an agent-based simulation model of a health care market composed of providers able to form ACO serving patients and embedded it in a conditional logit decision model to examine patients capable of choosing their care providers. This simulation focuses on Medicare beneficiaries and their congestive heart failure (CHF) outcomes. We place the patient agents in an ACO delivery system model in which provider agents decide if they remain in an ACO and perform a quality improving CHF disease management intervention. Illustrative results show that allowing patients to choose their providers reduces the yearly payment per CHF patient by $320, reduces mortality rates by 0.12 percentage points and hospitalization rates by 0.44 percentage points, and marginally increases provider participation in ACO. This study demonstrates a model capable of quantifying the effects of patient choice in a theoretical ACO system and provides a potential tool for policymakers to understand implications of patient choice and assess potential policy controls.

  19. Team dynamics, clinical work satisfaction, and patient care coordination between primary care providers: A mixed methods study.

    Science.gov (United States)

    Song, Hummy; Ryan, Molly; Tendulkar, Shalini; Fisher, Josephine; Martin, Julia; Peters, Antoinette S; Frolkis, Joseph P; Rosenthal, Meredith B; Chien, Alyna T; Singer, Sara J

    Team-based care is essential for delivering high-quality, comprehensive, and coordinated care. Despite considerable research about the effects of team-based care on patient outcomes, few studies have examined how team dynamics relate to provider outcomes. The aim of this study was to examine relationships among team dynamics, primary care provider (PCP) clinical work satisfaction, and patient care coordination between PCPs in 18 Harvard-affiliated primary care practices participating in Harvard's Academic Innovations Collaborative. First, we administered a cross-sectional survey to all 548 PCPs (267 attending clinicians, 281 resident physicians) working at participating practices; 65% responded. We assessed the relationship of team dynamics with PCPs' clinical work satisfaction and perception of patient care coordination between PCPs, respectively, and the potential mediating effect of patient care coordination on the relationship between team dynamics and work satisfaction. In addition, we embedded a qualitative evaluation within the quantitative evaluation to achieve a convergent mixed methods design to help us better understand our findings and illuminate relationships among key variables. Better team dynamics were positively associated with clinical work satisfaction and quality of patient care coordination between PCPs. Coordination partially mediated the relationship between team dynamics and satisfaction for attending clinicians, suggesting that higher satisfaction depends, in part, on better teamwork, yielding more coordinated patient care. We found no mediating effects for resident physicians. Qualitative results suggest that sources of satisfaction from positive team dynamics for PCPs may be most relevant to attending clinicians. Improving primary care team dynamics could improve clinical work satisfaction among PCPs and patient care coordination between PCPs. In addition to improving outcomes that directly concern health care providers, efforts to

  20. Quality evaluation in health care services based on customer-provider relationships.

    Science.gov (United States)

    Eiriz, Vasco; Figueiredo, José António

    2005-01-01

    To develop a framework for evaluating the quality of Portuguese health care organisations based on the relationship between customers and providers, to define key variables related to the quality of health care services based on a review of the available literature, and to establish a conceptual framework in order to test the framework and variables empirically. Systematic review of the literature. Health care services quality should not be evaluated exclusively by customers. Given the complexity, ambiguity and heterogeneity of health care services, the authors develop a framework for health care evaluation based on the relationship between customers (patients, their relatives and citizens) and providers (managers, doctors, other technical staff and non-technical staff), and considering four quality items (customer service orientation, financial performance, logistical functionality and level of staff competence). This article identifies important changes in the Portuguese health care industry, such as the ownership of health care providers. At the same time, customers are changing their attitudes towards health care, becoming much more concerned and demanding of health services. These changes are forcing Portuguese private and public health care organisations to develop more marketing-oriented services. This article recognises the importance of quality evaluation of health care services as a means of increasing customer satisfaction and organisational efficiency, and develops a framework for health care evaluation based on the relationship between customers and providers.

  1. Patient and provider perceptions of care for diabetes: results of the cross-national DAWN Study

    DEFF Research Database (Denmark)

    Peyrol, Mark; Rubin, Richard R.; Lauritzen, Torsten

    2006-01-01

    the relationships between outcomes and both country and respondent characteristics, and the interaction between these two factors. Results Providers rated chronic-care systems and remuneration for chronic care as mediocre. Patients reported that ease of access to care was high, but not without financial barriers....... Patients reported moderate levels of collaboration among providers, and providers indicated that several specialist disciplines were not readily available to them. Patients reported high levels of collaboration with providers in their own care. Provider endorsement of primary prevention strategies for type...... 2 diabetes was high. Patients with fewer socio-economic resources and more diabetes complications had lower access (and/or higher barriers) to care and lower quality of patient–provider collaboration. Countries differed significantly for all outcomes, and the relationships between respondent...

  2. Forging partnerships between rural women with chronic conditions and their health care providers.

    Science.gov (United States)

    Cudney, Shirley; Weinert, Clarann; Kinion, Elizabeth

    2011-03-01

    Successful adaptation to chronic illness is enhanced by active client-health care provider partnerships. The purposes of this article are to (a) examine the health care partnership needs of western rural women with chronic illness who participated in a computer-based support and education project, (b) describe how the role of the women in the partnership can be maximized by the use of a personal health record and improving health literacy, and (c) discuss ways health care providers can enhance their role in the partnership by careful listening and creating environments conducive to forging productive client-provider partnerships.

  3. Implementation of Provider Perspectives Resulted in Proper Health Care Resource Utilization

    National Research Council Canada - National Science Library

    Mclean, Hugh

    2001-01-01

    .... One such system is Provider Perspectives. This study shows that Provider Perspectives significantly decreased Emergency Room utilization and subsequently increased the usage of primary care clinics at Martin Army Community Hospital and Winn...

  4. Developmental Surveillance and Screening Practices by Pediatric Primary Care Providers: Implications for Early Intervention Professionals

    Science.gov (United States)

    Porter, Sallie; Qureshi, Rubab; Caldwell, Barbara Ann; Echevarria, Mercedes; Dubbs, William B.; Sullivan, Margaret W.

    2016-01-01

    This study used a survey approach to investigate current developmental surveillance and developmental screening practices by pediatric primary care providers in a diverse New Jersey county. A total of 217 providers were contacted with a final sample size of 57 pediatric primary care respondents from 13 different municipalities. Most providers…

  5. Service-Learning Linking Family Child Care Providers, Community Partners, and Preservice Professionals

    Science.gov (United States)

    Garner, Pamela W.; Parker, Tameka S.

    2016-01-01

    This article describes the implementation of a service-learning project, which was infused into a child development course. The project linked family child care providers, their licensing agency, and 39 preservice teachers in a joint effort to develop a parent handbook to be used by the providers in their child care businesses and to support…

  6. Child Care Providers' Strategies for Supporting Healthy Eating: A Qualitative Approach

    Science.gov (United States)

    Lynch, Meghan; Batal, Malek

    2012-01-01

    Recent research has revealed child care settings and providers to be important influences on children's developing behaviors. Yet most research on children's nutritional development has focused on home settings and parents. Thus, through semistructured interviews with child care providers, this study aimed to develop a better understanding of the…

  7. Views of parents and health-care providers regarding parental presence at bedside rounds in a neonatal intensive care unit.

    Science.gov (United States)

    Grzyb, M J; Coo, H; Rühland, L; Dow, K

    2014-02-01

    To examine the views of parents and health-care providers regarding parental presence during neonatal intensive care rounds. Cross-sectional survey of parents whose children were admitted to a tertiary-care neonatal intensive care unit (n=81). Medical trainees (n=67) and nurses (n=28) were also surveyed. The majority of parents reported that attending rounds reduced their anxiety and increased their confidence in the health-care team. Nurses were more likely than medical trainees to support parental presence at rounds (P=0.02). About three-quarters of medical trainees and nurses thought discussion is inhibited and 69% of trainees felt teaching is decreased when parents attend rounds. Most parents who attended rounds found the experience beneficial, but medical trainees' views were mixed. The positive impact on parents, and the learning opportunities created in family-centered care and communication when parents are present on rounds, should be highlighted for trainees and other neonatal intensive care personnel.

  8. Surgery and trauma care providers' perception of the impact of dual-practice employment on quality of care provided in an Andean country.

    Science.gov (United States)

    LaGrone, L N; Isquith-Dicker, L N; Huaman Egoavil, E; Herrera-Matta, J J; Fuhs, A K; Ortega Checa, D; Revoredo, F; Rodriguez Castro, M J A; Mock, C N

    2017-05-01

    Dual-practice, simultaneous employment by healthcare workers in the public and private sectors is pervasive worldwide. Although an estimated 30 per cent of the global burden of disease is surgical, the implications of dual practice on surgical care are not well understood. Anonymous in-depth individual interviews on trauma quality improvement practices were conducted with healthcare providers who participate in the care of the injured at ten large hospitals in Peru's capital city, Lima. A grounded theory approach to qualitative data analysis was employed to identify salient themes. Fifty interviews were conducted. A group of themes that emerged related to the perceived negative and positive impacts of dual practice on the quality of surgical care. Participants asserted that the majority of physicians in Lima working in the public sector also worked in the private sector. Dual practice has negative impacts on physicians' time, quality of care in the public sector, and surgical education. Dual practice positively affects patient care by allowing physicians to acquire management and quality improvement skills, and providing incentives for research and academic productivity. In addition, dual practice provides opportunities for clinical innovations and raises the economic status of the physician. Surgeons in Peru report that dual practice influences patient care negatively by creating time and human resource conflicts. Participants assert that these conflicts widen the gap in quality of care between rich and poor. This practice warrants redirection through national-level regulation of physician schedules and reorganization of public investment in health via physician remuneration. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  9. Older Adults’ Perceptions of Supporting Factors of Trust in a Robot Care Provider

    Directory of Open Access Journals (Sweden)

    Rachel E. Stuck

    2018-01-01

    Full Text Available The older adult population is increasing worldwide, leading to an increased need for care providers. An insufficient number of professional caregivers will lead to a demand for robot care providers to mitigate this need. Trust is an essential element for older adults and robot care providers to work effectively. Trust is context dependent. Therefore, we need to understand what older adults would need to trust robot care providers, in this specific home-care context. This mixed methods study explored what older adults, who currently receive assistance from caregivers, perceive as supporting trust in robot care providers within four common home-care tasks: bathing, transferring, medication assistance, and household tasks. Older adults reported three main dimensions that support trust: professional skills, personal traits, and communication. Each of these had subthemes including those identified in prior human-robot trust literature such as ability, reliability, and safety. In addition, new dimensions perceived to impact trust emerged such as the robot’s benevolence, the material of the robot, and the companionability of the robot. The results from this study demonstrate that the older adult-robot care provider context has unique dimensions related to trust that should be considered when designing robots for home-care tasks.

  10. Professional carers' experiences of providing a pediatric palliative care service in Ireland.

    Science.gov (United States)

    Clarke, Jean; Quin, Suzanne

    2007-11-01

    In this article the authors present findings on professional carers' experience of providing pediatric palliative care to children with life-limiting conditions. For this qualitative study, part of a national pediatric palliative care needs analysis, the authors engaged in 15 focus group interviews and drew on the responses of open-ended questions to give voice to the experiences of professional carers and to situate the humanity of their caring reality. This humanity is articulated through three themes: clarity of definition and complexity of engagement, seeking to deliver a palliative care service, and the emotional cost of providing palliative care. Further analysis of these themes points to a work-life experience of skilled and emotional engagement with children, and their parents, in complex processes of caregiving and decision making. Pediatric palliative care occurs in an environment where parents shoulder a large burden of the care and professionals find themselves working in underresourced services.

  11. Implementing Information and Communication Technology to Support Community Aged Care Service Integration: Lessons from an Australian Aged Care Provider

    OpenAIRE

    Douglas, Heather E; Georgiou, Andrew; Tariq, Amina; Prgomet, Mirela; Warland, Andrew; Armour, Pauline; Westbrook, Johanna I

    2017-01-01

    Introduction: There is limited evidence of the benefits of information and communication technology (ICT) to support integrated aged care services. Objectives: We undertook a case study to describe carelink+, a centralised client service management ICT system implemented by a large aged and community care service provider, Uniting. We sought to explicate the care-related information exchange processes associated with carelink+ and identify lessons for organisations attempting to use ICT to su...

  12. Understanding Older Adult's Perceptions of Factors that Support Trust in Human and Robot Care Providers.

    Science.gov (United States)

    Stuck, Rachel E; Rogers, Wendy A

    2017-06-01

    As the population of older adults increase so will the need for care providers, both human and robot. Trust is a key aspect to establish and maintain a successful older adult-care provider relationship. However, due to trust volatility it is essential to understand it within specific contexts. This proposed mixed methods study will explore what dimensions of trust emerge as important within the human-human and human-robot dyads in older adults and care providers. First, this study will help identify key qualities that support trust in a care provider relationship. By understanding what older adults perceive as needing to trust humans and robots for various care tasks, we can begin to provide recommendations based on user expectations for design to support trust.

  13. Identification of physicians providing comprehensive primary care in Ontario: a retrospective analysis using linked administrative data.

    Science.gov (United States)

    Schultz, Susan E; Glazier, Richard H

    2017-12-19

    Given the changing landscape of primary care, there may be fewer primary care physicians available to provide a broad range of services to patients of all age groups and health conditions. We sought to identify physicians with comprehensive primary care practices in Ontario using administrative data, investigating how many and what proportion of primary care physicians provided comprehensive primary care and how this changed over time. We identified the pool of active primary care physicians in linked population-based databases for Ontario from 1992/93 to 2014/15. After excluding those who saw patients fewer than 44 days per year, we identified physicians as providing comprehensive care if more than half of their services were for core primary care and if these services fell into at least 7 of 22 activity areas. Physicians with 50% or less of their services for core primary care but with more than 50% in a single location or type of service were identified as being in focused practice. In 2014/15, there were 12 891 physicians in the primary care pool: 1254 (9.7%) worked fewer than 44 days per year, 1619 (12.6%) were in focused practice, and 1009 (7.8%) could not be classified. The proportion in comprehensive practice ranged from 67.5% to 74.9% between 1992/93 and 2014/15, with a peak in 2002/03 and relative stability from 2009/10 to 2014/15. Over this period, there was an increase of 8.8% in population per comprehensive primary care physician. We found that just over two-thirds of primary care physicians provided comprehensive care in 2014/15, which indicates that traditional estimates of the primary care physician workforce may be too high. Although implementation will vary by setting and available data, this approach is likely applicable elsewhere. Copyright 2017, Joule Inc. or its licensors.

  14. Fostering a supportive moral climate for health care providers: Toward cultural safety and equity

    Directory of Open Access Journals (Sweden)

    Adel F. Almutairi

    Full Text Available In Western forms of health care delivery around the globe, research tells us that nurses experience excessive workloads as they face increasingly complex needs in the populations they serve, professional conflicts, and alienation from leadership in health care bureaucracies. These problems are practical and ethical as well as cultural. Cultural conflicts can arise when health care providers and the populations they serve come from diverse economic, ethnic, and cultural backgrounds. The purpose in this paper is to draw from Almutairi’s research with health care teams in Saudi Arabia to show the complexity of culturally and morally laden interactions between health care providers and patients and their families. Then, I will argue for interventions that promote social justice and cultural safety for nurses, other health care providers, and the individuals, families, and communities they serve. This will include addressing international implications for nursing practice, leadership, policy and research. Keywords: Moral climate, Social justice, Equity, Cultural diversity

  15. INFLUENCE OF SOCIOECONOMIC AND DEMOGRAPHIC ENVIRONMENT ON PRIVATE HEALTH CARE PROVIDERS

    Directory of Open Access Journals (Sweden)

    Lana Kordić

    2013-02-01

    Full Text Available Health care systems face pressure to increase the quality of health care at the same time with pressure to reduce public spending. The attempt to overcome the gap between needs and opportunities can be resolved through the introduction of public-private partnerships. Goals of this study are to investigate variation of the number, form and efficiency of private providers of general/family medicine services in primary health care and the contribution of socioeconomic and demographic environment on those variations, among counties. Socioeconomic and demographic factors are identified as independent variables that influence the health care need and utilization and consequently the decision of private entities to engage in the provision of health care services. This study extended previous studies because it has introduced socioeconomic and demographic variables. This may shed same new lights on the relationship between private providers of health service and efficiency of providing health service in primary health care.

  16. Systematic review of caregiver burden in spouses and partners providing informal care to wounded, injured or sick (WIS) military personnel.

    Science.gov (United States)

    Thandi, Gursimran; Harden, L; Cole, L; Greenberg, N; Fear, N T

    2018-02-12

    For the purposes of this review, caregivers are individuals who provide care that is typically unpaid and usually takes place at home. This systematic review aims to identify burden among spouses/partners caring for wounded, injured or sick military personnel and the factors associated with caregiver burden. A systematic review was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Five electronic databases and relevant websites were searched. Two reviewers appraised the quality of the studies and carried out data extraction. Ten original papers were identified, of which eight were quantitative studies and two were qualitative. These papers highlighted the potential negative impact caregiving can have on spouses/partners and also some of the positive aspects of caring that can strengthen intimate relationships. Caring for an injured or ill military spouse or partner is a difficult task, compounded by the complexity of dealing with potentially both their physical and mental health problems. However, research has also identified some positive aspects of caring that can strengthen intimate relationships. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  17. Iraqi primary care system in Kurdistan region: providers' perspectives on problems and opportunities for improvement.

    Science.gov (United States)

    Shabila, Nazar P; Al-Tawil, Namir G; Al-Hadithi, Tariq S; Sondorp, Egbert; Vaughan, Kelsey

    2012-09-27

    As part of a comprehensive study on the primary health care system in Iraq, we sought to explore primary care providers' perspectives about the main problems influencing the provision of primary care services and opportunities to improve the system. A qualitative study based on four focus groups involving 40 primary care providers from 12 primary health care centres was conducted in Erbil governorate in the Iraqi Kurdistan region between July and October 2010. A topic guide was used to lead discussions and covered questions on positive aspects of and current problems with the primary care system in addition to the priority needs for its improvement. The discussions were fully transcribed and the qualitative data was analyzed by content analysis, followed by a thematic analysis. Problems facing the primary care system included inappropriate health service delivery (irrational use of health services, irrational treatment, poor referral system, poor infrastructure and poor hygiene), health workforce challenges (high number of specialists, uneven distribution of the health workforce, rapid turnover, lack of training and educational opportunities and discrepancies in the salary system), shortage in resources (shortage and low quality of medical supplies and shortage in financing), poor information technology and poor leadership/governance. The greatest emphasis was placed on poor organization of health services delivery, particularly the irrational use of health services and the related overcrowding and overload on primary care providers and health facilities. Suggestions for improving the system included application of a family medicine approach and ensuring effective planning and monitoring. This study has provided a comprehensive understanding of the factors that negatively affect the primary care system in Iraq's Kurdistan region from the perspective of primary care providers. From their experience, primary care providers have a role in informing the community and

  18. Family centred care before and during life-sustaining treatment withdrawal in intensive care: A survey of information provided to families by Australasian critical care nurses

    OpenAIRE

    Ranse, K; Bloomer, M; Coombs, M; Endacott, R

    2016-01-01

    publisher: Elsevier articletitle: Family centred care before and during life-sustaining treatment withdrawal in intensive care: A survey of information provided to families by Australasian critical care nurses journaltitle: Australian Critical Care articlelink: http://dx.doi.org/10.1016/j.aucc.2016.08.006 content_type: article copyright: © 2016 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

  19. PROVIDER CHOICE FOR OUTPATIENT HEALTH CARE SERVICES IN INDONESIA: THE ROLE OF HEALTH INSURANCE

    Directory of Open Access Journals (Sweden)

    Budi Hidayat

    2012-11-01

    Full Text Available Background: Indonesian's health care system is characterized by underutilized of the health-care infrastructure. One of the ways to improve the demand for formal health care is through health insurance. Responding to this potentially effective policy leads the Government of Indonesia to expand health insurance coverage by enacting the National Social Security Act in 2004. In this particular issue, understanding provider choice is therefore a key to address the broader policy question as to how the current low uptake of health care services could be turned in to an optimal utilization. Objective:To estimate a model of provider choice for outpatient care in Indonesia with specific attention being paid to the role of health insurance. Methods: A total of 16485 individuals were obtained from the second wave of the Indonesian Family Life survey. A multinomial logit regression model was applied to a estimate provider choice for outpatient care in three provider alternative (public, private and self-treatment. A policy simulation is reported as to how expanding insurance benefits could change the patterns of provider choice for outpatient health care services. Results: Individuals who are covered by civil servant insurance (Askes are more likely to use public providers, while the beneficiaries of private employees insurance (Jamsostek are more likely to use private ones compared with the uninsured population. The results also reveal that less healthy, unmarried, wealthier and better educated individuals are more likely to choose private providers than public providers. Conclusions: Any efforts to improve access to health care through health insurance will fail if policy-makers do not accommodate peoples' preferences for choosing health care providers. The likely changes in demand from public providers to private ones need to be considered in the current social health insurance reform process, especially in devising premium policies and benefit packages

  20. Health care providers under pressure: making the most of challenging times.

    Science.gov (United States)

    Davis, Scott B; Robinson, Phillip J

    2010-01-01

    Whether the slowing economic recovery, tight credit markets, increasing costs, or the uncertainty surrounding health care reform, the health care industry faces some sizeable challenges. These factors have put considerable strain on the industry's traditional financing options that the industry has relied on in the past--bonds, banks, finance companies, private equity, venture capital, real estate investment trusts, private philanthropy, and grants. At the same time, providers are dealing with rising costs, lower reimbursement rates, shrinking demand for elective procedures, higher levels of charitable care and bad debt, and increased scrutiny of tax-exempt hospitals. Providers face these challenges against a back ground of uncertainty created by health care reform.

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

    Science.gov (United States)

    Agarwal, Vinita

    2017-11-01

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

  2. Impact of prenatal care provider on the use of ancillary health services during pregnancy

    Science.gov (United States)

    2013-01-01

    Background Recent declines in the provision of prenatal care by family physicians and the integration of midwives into the Canadian health care system have led to a shift in the pattern of prenatal care provision; however it is unknown if this also impacts use of other health services during pregnancy. This study aimed to assess the impact of the type of prenatal care provider on the self-reported use of ancillary services during pregnancy. Methods Data for this study was obtained from the All Our Babies study, a community-based prospective cohort study of women’s experiences during pregnancy and the post-partum period. Chi-square tests and logistic regression were used to assess the association between type of prenatal care provider and use of ancillary health services in pregnancy. Results During pregnancy, 85.8% of women reported accessing ancillary health services. Compared to women who received prenatal care from a family physician, women who saw a midwife were less likely to call a nurse telephone advice line (OR = 0.30, 95% CI: 0.18-0.50) and visit the emergency department (OR = 0.47, 95% CI: 0.24-0.89), but were more likely receive chiropractic care (OR = 4.07, 95% CI: 2.49-6.67). Women who received their prenatal care from an obstetrician were more likely to visit a walk-in clinic (OR = 1.51, 95% CI: 1.11-2.05) than those who were cared for by a family physician. Conclusions Prenatal care is a complex entity and referral pathways between care providers and services are not always clear. This can lead to the provision of fragmented care and create opportunities for errors and loss of information. All types of care providers have a role in addressing the full range of health needs that pregnant women experience. PMID:23497179

  3. Provision of care to clients of migrant origin: the experiences of maternity care providers.

    NARCIS (Netherlands)

    Boerleider, A.W.; Francke, A.L.; Wiegers, T.A.; Manniën, J.; Devillé, W.L.J.M.

    2012-01-01

    Background: Women of non-western migrant origin comprise a substantial part of the client population in maternity care. According to Statistics Netherlands, mothers of non-western migrant origin contribute to 17% of all live births. This group is very diverse in origin which implies a variety in

  4. Why self-care is key to providing high-quality care to others.

    Science.gov (United States)

    McCormick, Jo; Hayes, Sally

    2017-06-22

    Jo McCormick, Consultant Nurse and Associate Director of Nursing, Belfast Health and Social Care Trust, Joanna.McCormick@belfasttrust.hscni.net , and Sally Hayes, Director of Strategy, Planning and Resources at the Open University, share their insights from undertaking a Florence Nightingale Leadership Scholarship.

  5. Coping of health care providers with the death of a patient

    Directory of Open Access Journals (Sweden)

    Aleksander Mlinšek

    2012-10-01

    Full Text Available RQ: With an aging population, health care professionals are often faced with the death of a patient in acute hospitals. The experience of dying patients’ to health care professionals and to the health care system brings many challenges that need to be faced.Purpose: The present study was to determine how health care providers are faced with the death of a patient, what is the care needed for the dying patient and how to participate in interdisciplinary team care of among themselves and family members of dying patients.Method: We conducted a small-scale quantitative survey of nursing care in a Slovenian acute hospital. To analyze the results, we used frequency statistics and Pearson's correlation coefficient.Results: Health care providers need additional skills needed to care for a dying patient as well as to the family of the dying patient.They try to control distress of the dying experience reasonably and less with conversation. The effect on the loss of a patient affects work experience, but we did not notice any other effects. Theinvolvement of an interdisciplinary team in the care of the dying patient is satisfactory; family members are under-involved in the care.Organization: Health organizations that are more focused on acute treatment have to become aware of palliative care that needs to be included in nursing care as an integral process of care for the terminally ill. Health care staff need to communicate more with one another and go through additional training.Society: Attitudes to death in a broader cultural environment also affects the attitude of health workers towards death. Involvement of the social environment, especially family members, is very important.Originality: The survey was conducted on the basis of comparing two surveys.Limitations: The survey was conducted on a small sample size.

  6. Organisational and environmental characteristics of residential aged care units providing highly person-centred care: a cross sectional study.

    Science.gov (United States)

    Sjögren, Karin; Lindkvist, Marie; Sandman, Per-Olof; Zingmark, Karin; Edvardsson, David

    2017-01-01

    Few studies have empirically investigated factors that define residential aged care units that are perceived as being highly person-centred. The purpose of this study was to explore factors characterising residential aged care units perceived as being highly person-centred, with a focus on organisational and environmental variables, as well as residents' and staff' characteristics. A cross-sectional design was used. Residents ( n  = 1460) and staff ( n  = 1213) data from 151 residential care units were collected, as well as data relating to characteristics of the organisation and environment, and data measuring degree of person-centred care. Participating staff provided self-reported data and conducted proxy ratings on residents . Descriptive and comparative statistics, independent samples t-test, Chi 2 test, Eta Squared and Phi coefficient were used to analyse data. Highly person-centred residential aged care units were characterized by having a shared philosophy of care, a satisfactory leadership, interdisciplinary collaboration and social support from colleagues and leaders, a dementia-friendly physical environment, staff having time to spend with residents, and a smaller unit size. Residential aged care units with higher levels of person-centred care had a higher proportion of staff with continuing education in dementia care, and a higher proportion of staff receiving regular supervision, compared to units with lower levels of person-centred care. It is important to target organisational and environmental factors, such as a shared philosophy of care, staff use of time, the physical environment, interdisciplinary support, and support from leaders and colleagues, to improve person-centred care in residential care units. Managers and leaders seeking to facilitate person-centred care in daily practice need to consider their own role in supporting, encouraging, and supervising staff.

  7. African American women and prenatal care: perceptions of patient-provider interaction.

    Science.gov (United States)

    Dahlem, Chin Hwa Y; Villarruel, Antonia M; Ronis, David L

    2015-02-01

    Poor patient-provider interaction among racial/ethnic minorities is associated with disparities in health care. In this descriptive, cross-sectional study, we examine African American women's perspectives and experiences of patient-provider interaction (communication and perceived discrimination) during their initial prenatal visit and their influences on perceptions of care received and prenatal health behaviors. Pregnant African American women (n = 204) and their providers (n = 21) completed a pre- and postvisit questionnaire at the initial prenatal visit. Women were also interviewed face to face at the subsequent return visit. Women perceived high quality patient-provider communication (PPC) and perceived low discrimination in their interaction with providers. Multiple regression analyses showed that PPC had a positive effect on trust in provider (p prenatal care satisfaction (p prenatal health behaviors. Findings suggest that quality PPC improves the prenatal care experience for African American women. © The Author(s) 2014.

  8. Empowering nurses in providing palliative care to cancer patients: Action research study

    Directory of Open Access Journals (Sweden)

    Fariba Taleghani

    2018-01-01

    Full Text Available Background: Chronic diseases such as cancer would lead to various health needs in patients and their families. To meet needs, developing new educational nursing courses is necessary. Therefore this study was conducted to empower nurses through designing and conducting short-term educational courses for training palliative care nurses. Materials and Methods: This study was a community-based action research which was conducted at Isfahan hospitals that provide services for cancer patients during 2015 at four stages (planning, acting, reflection, and evaluation. Participants (33 samples included nurses, head nurses, managers of nursing services, nursing professors and professors of oncology department. Data were gathered through individual and group interviews and analyzed using content analysis. Results: Data analysis resulted in 3 categories of "professional development of nursing in palliative care" which included subcategories of: knowledge-based performance and positive change in attitude, "obstacles to provide palliative care" with subcategories of: insufficient professional responsibility, insufficient ability in managing some of patients' symptoms and inappropriate interaction between nurses and physicians and "strategies for improving provision of palliative care" with subcategories of: improving the interactions between physicians and nurses, continuous trainings for palliative care and the necessity of developing palliative care in the country. Conclusions: To facilitate the process of providing palliative care to cancer patients, necessary actions and measures must be conducted including improvement of interaction between the members of health team, organizing continuing educational courses on palliative care and development of providing palliative care all over the country by managers of health centers.

  9. Interest in Providing Multiple Sclerosis Care and Subspecializing in Multiple Sclerosis Among Neurology Residents

    Science.gov (United States)

    Teixeira-Poit, Stephanie; Kane, Heather L.; Frost, A. Corey; Keating, Michael; Olmsted, Murrey

    2014-01-01

    Background: Although detailed knowledge regarding treatment options for multiple sclerosis (MS) patients is largely limited to neurologists, shortages in the neurologist workforce, including MS subspecialists, are predicted. Thus, MS patients may have difficulties in gaining access to appropriate care. No systematic evaluation has yet been performed of the number of neurology residents planning to pursue MS subspecialization. This study identifies factors affecting interest in providing MS patient care or MS subspecialization among current neurology residents. Methods: We randomly selected half of all Accreditation Council of Graduate Medical Education–certified neurology residency programs in the continental United States to receive the neurology resident survey. Completed surveys were received from 218 residents. Results: Residents were significantly more likely to have increased interest in MS care when they participated in MS research, were interested in teaching, and indicated that the “ability to improve patient outcomes and quality of life” was a positive factor influencing their desire to provide MS patient care. Residents who were interested in providing MS care, interested in teaching, and indicated that “research opportunities” was a positive factor for providing MS patient care were significantly more likely to express interest in MS subspecialization. Conclusions: Increasing opportunities to interact with MS patients, learn about MS care, and participate in MS research may increase interest in MS care and subspecialization among neurology residents. Opportunities to educate residents regarding MS patient care may affect residents’ attitudes. PMID:24688352

  10. Factors Associated with Providers' Perceptions of Mental Health Care in Santa Luzia's Family Health Strategy, Brazil.

    Science.gov (United States)

    Ghesquiere, Angela R; Pinto, Rogerio M; Rahman, Rahbel; Spector, Anya Y

    2015-12-23

    Brazil has a unique mental health care system, characterized by universal coverage delivered by interdisciplinary teams both in the community and in specialized centros de atenção psicossocial (CAPS-psychosocial care centers). Provision of patient-centered mental health care is an important principle of Brazilian mental health care, but this topic has not been well-studied. We analyzed data from a cross-sectional survey of 151 community health workers (CHWs), nurses, and physicians in Santa Luzia, Minas Gerais State, Brazil. Chi-squares, t-tests and multivariate regression analyses examined differences in socio-demographics, caseload, engagement in evidence-based practices (EBPs), and transdisciplinary collaboration between providers who reported providing high levels of patient-centered mental health care and those who did not. In multivariate regression models, components of transdisciplinary collaboration were significantly associated with providers' perceptions of patient-centered mental health care (p < 0.05). CHWs were also significantly more likely to report providing patient-centered care than physicians and nurses. EBP engagement and sociodemographics were not associated with perceptions. Results suggest that training efforts to improve patient-centered mental health care in Brazil could build upon CHWs' skills and focus on transdisciplinary collaboration. Findings may inform practice in other countries with similar health care systems.

  11. Educational Needs of Health Care Providers Working in Long-Term Care Facilities with Regard to Pain Management

    Directory of Open Access Journals (Sweden)

    Yannick Tousignant-Laflamme

    2012-01-01

    Full Text Available BACKGROUND: The prevalence of chronic pain ranges from 40% to 80% in long-term care facilities (LTCF, with the highest proportion being found among older adults and residents with dementia. Unfortunately, pain in older adults is underdiagnosed, undertreated, inadequately treated or not treated at all. A solution to this problem would be to provide effective and innovative interdisciplinary continuing education to health care providers (HCPs.

  12. Communication strategies and accommodations utilized by health care providers with hearing loss: a pilot study.

    Science.gov (United States)

    Trotter, Alanna R; Matt, Susan B; Wojnara, Danuta

    2014-03-01

    Poor communication between health care providers and patients may negatively impact patient outcomes, and enhancing communication is one way to improve outcomes. Effective communication is particularly important for health care providers who have hearing loss. The authors found that a systematic survey of the communication strategies and experiences of health care providers with hearing loss had not yet been conducted. In this pilot study, 32 health care professionals with hearing loss were recruited via the Association of Medical Professionals With Hearing Losses and were asked to complete a 28-question survey. Health care providers with hearing loss already employ strategies that all health care providers are encouraged to use in order to enhance patient–provider communication, and survey participants have found the strategies to be effective. The communication techniques and assistive technologies used by individuals with hearing loss seem to be effective: All participants reported feeling able to communicate effectively with patients at least most of the time. More research is needed to determine if use of these communication techniques has similar results for health care providers without hearing loss.

  13. Quality of care provided to patients with diabetes mellitus in Puerto Rico; managed care versus fee-for-service experience.

    Science.gov (United States)

    Rodríguez-Vigil, Efraín; Kianes-Pérez, Zaira

    2005-01-01

    To evaluate and compare the quality of diabetes care in a large managed care system and fee-for-service payment system in Puerto Rico. This retrospective cross-sectional study assessed the adherence to standards of diabetes care in 1,687,202 subjects--226,210 from a fee-for-service population and 1,460,992 from a managed care group. Patients with diabetes mellitus were identified from insurance claims reports. Type of health-care provider, service location, number of visits, and laboratory utilization were also assessed. From the analysis, we identified 90,616 patients with diabetes (5.4% of the overall study group). Of these, 66,587 (73.5%) were found to have at least one encounter with a physician in a medical visit. Of the 66,586 patients with diabetes who visited a physician, only 4% were treated by an endocrinologist. General laboratory utilization was 34% for the entire population of patients with diabetes studied. In the group of patients with documented laboratory tests, 93% had a documented fasting blood glucose test; in contrast, hemoglobin A lc testing was performed in only 9% of the patients. The fee-for-service group had a higher rate of visits to medical specialists and general laboratory utilization, whereas the managed care group had a higher rate of hospital admissions and emergency department visits. The quality of diabetes management and the subsequent outcomes are related to patient and health-care provider adherence to standards of care. In this analysis, we found that patients and physicians are responsible for low compliance with recognized standards of diabetes care in Puerto Rico. The lack of adequate management will lead to increased mortality, development and severity of chronic complications, and increased emergency department utilization. Therefore, health-care providers and payers should find ways to achieve more effective promotion of adherence to accepted standards of care for patients with diabetes.

  14. The relationship of primary care providers to dental practitioners in rural and remote Australia.

    Science.gov (United States)

    Barnett, Tony; Hoang, Ha; Stuart, Jackie; Crocombe, Len

    2017-08-01

    Rural residents have poorer oral health and more limited access to dental services than their city counterparts. In rural communities, health care professionals often work in an extended capacity due to the needs of the community and health workforce shortages in these areas. Improved links and greater collaboration between resident rural primary care and dental practitioners could help improve oral health service provision such that interventions are both timely, effective and lead to appropriate follow-up and referral. This study examined the impact oral health problems had on primary health care providers; how primary care networks could be more effectively utilised to improve the provision of oral health services to rural communities; and identified strategies that could be implemented to improve oral health. Case studies of 14 rural communities across three Australian states. Between 2013 and 2016, 105 primary and 12 dental care providers were recruited and interviewed. Qualitative data were analysed in Nvivo 10 using thematic analysis. Quantitative data were subject to descriptive analysis using SPSSv20. Rural residents presented to primary care providers with a range of oral health problems from "everyday" to "10 per month". Management by primary care providers commonly included short-term pain relief, antibiotics, and advice that the patient see a dentist. The communication between non-dental primary care providers and visiting or regional dental practitioners was limited. Participants described a range of strategies that could contribute to better oral health and oral health oral services in their communities. Rural oral health could be improved by building oral health capacity of non-dental care providers; investing in oral health promotion and prevention activities; introducing more flexible service delivery practices to meet the dental needs of both public and private patients; and establishing more effective communication and referral pathways between

  15. Barriers and facilitators to provide quality TIA care in the Veterans Healthcare Administration.

    Science.gov (United States)

    Damush, Teresa M; Miech, Edward J; Sico, Jason J; Phipps, Michael S; Arling, Greg; Ferguson, Jared; Austin, Charles; Myers, Laura; Baye, Fitsum; Luckhurst, Cherie; Keating, Ava B; Moran, Eileen; Bravata, Dawn M

    2017-12-12

    To identify key barriers and facilitators to the delivery of guideline-based care of patients with TIA in the national Veterans Health Administration (VHA). We conducted a cross-sectional, observational study of 70 audiotaped interviews of multidisciplinary clinical staff involved in TIA care at 14 VHA hospitals. We de-identified and analyzed all transcribed interviews. We identified emergent themes and patterns of barriers to providing TIA care and of facilitators applied to overcome these barriers. Identified barriers to providing timely acute and follow-up TIA care included difficulties accessing brain imaging, a constantly rotating pool of housestaff, lack of care coordination, resource constraints, and inadequate staff education. Key informants revealed that both stroke nurse coordinators and system-level factors facilitated the provision of TIA care. Few facilities had specific TIA protocols. However, stroke nurse coordinators often expanded upon their role to include TIA. They facilitated TIA care by (1) coordinating patient care across services, communicating across service lines, and educating clinical staff about facility policies and evidence-based practices; (2) tracking individual patients from emergency departments to inpatient settings and to discharge for timely follow-up care; (3) providing and referring TIA patients to risk factor management programs; and (4) performing regular audit and feedback of quality performance data. System-level facilitators included clinical service leadership engagement and use of electronic tools for continuous care across services. The local organization within a health care facility may be targeted to cultivate internal facilitators and a systemic infrastructure to provide evidence-based TIA care. Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

  16. Auditing the needs of recovery room staff providing care for the child in an acute hospital.

    Science.gov (United States)

    Nicholas-Holley, J

    2016-05-01

    This article examines the results of an audit into recovery nurse knowledge and understanding of paediatric care standards. It will critically analyse the availability of current standards for children's services in the recovery room and discuss the need for a national document specifically dedicated to standards of practise for the care of the child in the recovery room providing immediate post operative care. The article will also look at the development of such a document.

  17. A qualitative description of service providers' experiences of ethical issues in HIV care.

    Science.gov (United States)

    Sabone, Motshedisi B; Mogobe, Keitshokile Dintle; Matshediso, Ellah; Shaibu, Sheila; Ntsayagae, Esther I; Corless, Inge B; Cuca, Yvette P; Holzemer, William L; Dawson-Rose, Carol; Baez, Solymar S Soliz; Rivero-Mendz, Marta; Webel, Allison R; Eller, Lucille Sanzero; Reid, Paula; Johnson, Mallory O; Kemppainen, Jeanne; Reyes, Darcel; Nokes, Kathleen; Wantland, Dean; Nicholas, Patrice K; Lingren, Teri; Portillo, Carmen J; Sefcik, Elizabeth; Long-Middleton, Ellen

    2018-01-01

    Managing HIV treatment is a complex multi-dimensional task because of a combination of factors such as stigma and discrimination of some populations who frequently get infected with HIV. In addition, patient-provider encounters have become increasingly multicultural, making effective communication and provision of ethically sound care a challenge. This article explores ethical issues that health service providers in the United States and Botswana encountered in their interaction with patients in HIV care. A descriptive qualitative design was used to collect data from health service providers and patients using focused group discussions. This article is based on responses from health service providers only. Participants and context: This article is based on 11 focused group discussions with a total sample of 71 service providers in seven US sites and one Botswana site. Ethical considerations: Ethical review boards at all the study sites reviewed the study protocol and approved it. Ethical review boards of the study's coordinating centers, Rutgers University and the University of California at San Francisco, also approved it. The study participants provided a written informed consent to participate. HIV service providers encountered ethical challenges in all the four Beauchamp and Childress' biomedical ethics of respect for patients' autonomy, beneficence, justice, and nonmaleficence. The finding that HIV service providers encounter ethical challenges in their interaction with patients is supported by prior studies. The ethical challenges are particularly prominent in multicultural care and resource-constrained care environments. Provision of HIV care is fraught with ethical challenges that tend to pose different issues depending on a given care environment. It is important that strong partnerships are developed among key stakeholders in HIV care. In addition, health service providers need to be provided with resources so they can provide quality and ethically sound

  18. Serious gaming: A tool to educate health care providers about domestic violence.

    Science.gov (United States)

    Mason, Robin; Turner, Linda

    2018-05-10

    Due to many adverse health effects, victims of domestic violence are frequently seen in the health care system. Yet, health care providers may lack the training to assist them. Online curricula can be an effective instructional tool. Our competency-based, serious video game, Responding to Domestic Violence in Clinical Settings, was designed to address health care providers' knowledge gaps through 17 modules, each a half hour in length. Nearly 9,000 participants completed at least one module; nursing students completed the most modules, approximately five hours of instruction. This serious video game-based curriculum is useful in helping health providers and students learn about Domestic Violence.

  19. Video Modeling Training Effects on Types of Attention Delivered by Educational Care-Providers.

    Science.gov (United States)

    Taber, Traci A; Lambright, Nathan; Luiselli, James K

    2017-06-01

    We evaluated the effects of abbreviated (i.e., one-session) video modeling on delivery of student-preferred attention by educational care-providers. The video depicted a novel care-provider interacting with and delivering attention to the student. Within a concurrent multiple baseline design, video modeling increased delivery of the targeted attention for all participants as well as their delivery of another type of attention that was not trained although these effects were variable within and between care-providers. We discuss the clinical and training implications from these findings.

  20. Interventions to provide culturally-appropriate maternity care services: factors affecting implementation.

    Science.gov (United States)

    Jones, Eleri; Lattof, Samantha R; Coast, Ernestina

    2017-08-31

    The World Health Organization recently made a recommendation supporting 'culturally-appropriate' maternity care services to improve maternal and newborn health. This recommendation results, in part, from a systematic review we conducted, which showed that interventions to provide culturally-appropriate maternity care have largely improved women's use of skilled maternity care. Factors relating to the implementation of these interventions can have implications for their success. This paper examines stakeholders' perspectives and experiences of these interventions, and facilitators and barriers to implementation; and concludes with how they relate to the effects of the interventions on care-seeking outcomes. We based our analysis on 15 papers included in the systematic review. To extract, collate and organise data on the context and conditions from each paper, we adapted the SURE (Supporting the Use of Research Evidence) framework that lists categories of factors that could influence implementation. We considered information from the background and discussion sections of papers included in the systematic review, as well as cost data and qualitative data when included. Women's and other stakeholders' perspectives on the interventions were generally positive. Four key themes emerged in our analysis of facilitators and barriers to implementation. Firstly, interventions must consider broader economic, geographical and social factors that affect ethnic minority groups' access to services, alongside providing culturally-appropriate care. Secondly, community participation is important in understanding problems with existing services and potential solutions from the community perspective, and in the development and implementation of interventions. Thirdly, respectful, person-centred care should be at the core of these interventions. Finally, cohesiveness is essential between the culturally-appropriate service and other health care providers encountered by women and their

  1. Resident Dyads Providing Transition Care to Adolescents and Young Adults With Chronic Illnesses and Neurodevelopmental Disabilities.

    Science.gov (United States)

    Chung, Richard J; Jasien, Joan; Maslow, Gary R

    2017-04-01

    Youth with special health care needs often experience difficulty transitioning from pediatric to adult care. These difficulties may derive in part from lack of physician training in transition care and the challenges health care providers experience establishing interdisciplinary partnerships to support these patients. This educational innovation sought to improve pediatrics and adult medicine residents' interdisciplinary communication and collaboration. Residents from pediatrics, medicine-pediatrics, and internal medicine training programs participated in a transitions clinic for patients with chronic health conditions aged 16 to 26 years. Residents attended 1 to 4 half-day clinic sessions during 1-month ambulatory rotations. Pediatrics/adult medicine resident dyads collaboratively performed psychosocial and medical transition consultations that addressed health care navigation, self-care, and education and vocation topics. Two to 3 attending physicians supervised each clinic session (4 hours) while concurrently seeing patients. Residents completed a preclinic survey about baseline attitudes and experiences, and a postclinic survey about their transitions clinic experiences, changes in attitudes, and transition care preparedness. A total of 46 residents (100% of those eligible) participated in the clinic and completed the preclinic survey, and 25 (54%) completed the postclinic survey. A majority of respondents to the postclinic survey reported positive experiences. Residents in both pediatrics and internal medicine programs reported improved preparedness for providing transition care to patients with chronic health conditions and communicating effectively with colleagues in other disciplines. A dyadic model of collaborative transition care training was positively received and yielded improvements in immediate self-assessed transition care preparedness.

  2. Six health care trends that will reshape the patient-provider dynamic.

    Science.gov (United States)

    Liao, Joshua M; Emanuel, Ezekiel J; Navathe, Amol S

    2016-09-01

    Six trends - movement towards value-based payment, rapid adoption of digital health technology, care delivery in non-traditional settings, development of individualized clinical guidelines, increased transparency, and growing cultural awareness about the harms of medical overuse - are driving the US health care system towards a future defined by quality- and patient-centric care. Health care organizations are responding to these changes by implementing provider and workforce changes, pursuing stronger payer-provider integration, and accelerating the use of digital technology and data. While these efforts can also improve the clinical relationship and create positive system redesign among health care organizations, they require alignment between organizational and physician incentives that can inadvertently harm the dynamic between patients and providers. Organizations can utilize several strategies to preserve the patient-physician relationship and advance the positive benefits of new organizational strategies while guarding against unintended consequences. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Transitions from hospital to community care: the role of patient-provider language concordance.

    Science.gov (United States)

    Rayan, Nosaiba; Admi, Hanna; Shadmi, Efrat

    2014-01-01

    Cultural and language discordance between patients and providers constitutes a significant challenge to provision of quality healthcare. This study aims to evaluate minority patients' discharge from hospital to community care, specifically examining the relationship between patient-provider language concordance and the quality of transitional care. This was a multi-method prospective study of care transitions of 92 patients: native Hebrew, Russian or Arabic speakers, with a pre-discharge questionnaire and structured observations examining discharge preparation from a large Israeli teaching hospital. Two weeks post-discharge patients were surveyed by phone, on the transition from hospital to community care (the Care Transition Measure (CTM-15, 0-100 scale)) and on the primary-care post-discharge visit. Overall, ratings on the CTM indicated fair quality of the transition process (scores of 51.8 to 58.8). Patient-provider language concordance was present in 49% of minority patients' discharge briefings. Language concordance was associated with higher CTM scores among minority groups (64.1 in language-concordant versus 49.8 in non-language-concordant discharges, P Language-concordant care, coupled with extensive discharge briefings and post-discharge explanations for ongoing care, are important contributors to the quality of care transitions of ethnic minority patients.

  4. Women's descriptions of childbirth trauma relating to care provider actions and interactions.

    Science.gov (United States)

    Reed, Rachel; Sharman, Rachael; Inglis, Christian

    2017-01-10

    Many women experience psychological trauma during birth. A traumatic birth can impact on postnatal mental health and family relationships. It is important to understand how interpersonal factors influence women's experience of trauma in order to inform the development of care that promotes optimal psychosocial outcomes. As part of a large mixed methods study, 748 women completed an online survey and answered the question 'describe the birth trauma experience, and what you found traumatising'. Data relating to care provider actions and interactions were analysed using a six-phase inductive thematic analysis process. Four themes were identified in the data: 'prioritising the care provider's agenda'; 'disregarding embodied knowledge'; 'lies and threats'; and 'violation'. Women felt that care providers prioritised their own agendas over the needs of the woman. This could result in unnecessary intervention as care providers attempted to alter the birth process to meet their own preferences. In some cases, women became learning resources for hospital staff to observe or practice on. Women's own embodied knowledge about labour progress and fetal wellbeing was disregarded in favour of care provider's clinical assessments. Care providers used lies and threats to coerce women into complying with procedures. In particular, these lies and threats related to the wellbeing of the baby. Women also described actions that were abusive and violent. For some women these actions triggered memories of sexual assault. Care provider actions and interactions can influence women's experience of trauma during birth. It is necessary to address interpersonal birth trauma on both a macro and micro level. Maternity service development and provision needs to be underpinned by a paradigm and framework that prioritises both the physical and emotional needs of women. Care providers require training and support to minimise interpersonal birth trauma.

  5. Communication and cultural issues in providing reproductive health care to immigrant women: health care providers' experiences in meeting the needs of [corrected] Somali women living in Finland.

    Science.gov (United States)

    Degni, Filio; Suominen, Sakari; Essén, Birgitta; El Ansari, Walid; Vehviläinen-Julkunen, Katri

    2012-04-01

    Communication problems due to language and cultural differences between health care professionals and patients are widely recognized. Finns are described as more silent whereas one concurrent large immigrant group, the Somalis, are described as more open in their communication. The aim of the study was to explore physicians-nurses/midwives' communication when providing reproductive and maternity health care to Somali women in Finland. Four individual and three focus group interviews were carried out with 10 gynecologists/obstetricians and 15 nurses/midwives from five selected clinics. The health care providers considered communication (including linguistic difficulties), cultural traditions, and religious beliefs to be problems when working with Somali women. Male and female physicians were generally more similar in communication style, interpersonal contacts, and cultural awareness than the nurses/midwives who were engaged in more partnership-building with the Somali women in the clinics. Despite the communication and cultural problems, there was a tentative mutual understanding between the Finnish reproductive health care professionals and the Somali women in the clinics.

  6. Variations in levels of care within a hospital provided to acute ...

    African Journals Online (AJOL)

    Variations in levels of care within a hospital provided to acute trauma patients. ... A scoring system was devised to classify the quality of the observations that each patient received in the different ... Observations in the intensive care unit (ICU) and operating theatre were uniformly excellent. In the ... HOW TO USE AJOL.

  7. Child Care Provider Awareness and Prevention of Cytomegalovirus and Other Infectious Diseases

    Science.gov (United States)

    Thackeray, Rosemary; Magnusson, Brianna M.

    2016-01-01

    Background: Child care facilities are prime locations for the transmission of infectious and communicable diseases. Children and child care providers are at high risk for cytomegalovirus (CMV) infection which causes severe birth defects and developmental delays. Objective: The goals of study were: (1) to determine the level of cytomegalovirus…

  8. Strategic behaviour of institutional providers in mental handicapped care in the Netherlands

    NARCIS (Netherlands)

    van Harten, Willem H.; Veldhuis, Marleen J.M.; Hoeksma, Bernhard H.; Krabbendam, Johannes Jacobus

    2007-01-01

    Purpose – The purpose of this paper is to describe an inventory of the strategic responses of institutional providers of mental handicapped care to the strengthening of consumer choice through a personal care budget (PCB) Design/methodology/approach – Semi structured interviews were conducted among

  9. [Training future nurses in providing care for patients who committed criminal acts].

    Science.gov (United States)

    Corvest, Karina; Royer, Gilles Ripaille-Le; Dugardin, Thierry

    2011-01-01

    Providing care for patients who have carried out criminal acts is a source of questioning for caregivers, who must position themselves in this specific care relationship. For three years, the nursing training institute (IFSI) in Orthez has offered students an optional module in criminology. Through discussions and critical reflection, its aim is to enable future nurses to be better prepared.

  10. The Assessment of Athletic Training Students' Knowledge and Behavior to Provide Culturally Competent Care

    Science.gov (United States)

    Nynas, Suzette Marie

    2015-01-01

    Context: Culturally competent knowledge and skills are critical for all healthcare professionals to possess in order to provide the most appropriate health care for their patients and clients. Objective: To investigate athletic training students' knowledge of culture and cultural differences, to assess the practice of culturally competent care,…

  11. The Relationship between Practices and Child Care Providers' Beliefs Related to Child Feeding and Obesity Prevention

    Science.gov (United States)

    Lanigan, Jane D.

    2012-01-01

    Objective: To examine the association between child care practices and child care provider knowledge and beliefs about their role in supporting children's healthful eating. Design: Longitudinal design using survey and observation data from baseline and year 1 of the Encouraging Healthy Activity and Eating in Childcare Environments (ENHANCE) pilot…

  12. Family Caregiving for Patients With Heart Failure : Types of Care Provided and Gender Differences

    NARCIS (Netherlands)

    Hwang, Boyoung; Luttik, Marie Louise; Dracup, Kathleen; Jaarsma, Tiny

    Background: Knowledge about the potential burden for family caregivers related to the care of patients with heart failure (HF) is limited. The aims of the study were to compare the kind and amount of care provided by partners of HF patients and partners of healthy individuals and to examine the

  13. Development and Validation of Quality Criteria for Providing Patient- and Family-centered Injury Care.

    Science.gov (United States)

    Boyd, Jamie M; Burton, Rachael; Butler, Barb L; Dyer, Dianne; Evans, David C; Felteau, Melissa; Gruen, Russell L; Jaffe, Kenneth M; Kortbeek, John; Lang, Eddy; Lougheed, Val; Moore, Lynne; Narciso, Michelle; Oxland, Peter; Rivara, Frederick P; Roberts, Derek; Sarakbi, Diana; Vine, Karen; Stelfox, Henry T

    2017-08-01

    The aim of this study was to develop and evaluate the content validity of quality criteria for providing patient- and family-centered injury care. Quality criteria have been developed for clinical injury care, but not patient- and family-centered injury care. Using a modified Research AND Development Corporation (RAND)/University of California, Los Angeles (UCLA) Appropriateness Methodology, a panel of 16 patients, family members, injury and quality of care experts serially rated and revised criteria for patient- and family-centered injury care identified from patient and family focus groups. The criteria were then sent to 384 verified trauma centers in the United States, Canada, Australia, and New Zealand for evaluation. A total of 46 criteria were rated and revised by the panel over 4 rounds of review producing 14 criteria related to clinical care (n = 4; transitions of care, pain management, patient safety, provider competence), communication (n = 3; information for patients/families; communication of discharge plans to patients/families, communication between hospital and community providers), holistic care (n = 4; patient hygiene, kindness and respect, family access to patient, social and spiritual support) and end-of-life care (n = 3; decision making, end-of-life care, family follow-up). Medical directors, managers, or coordinators representing 254 trauma centers (66% response rate) rated 12 criteria to be important (95% of responses) for patient- and family-centered injury care. Fewer centers rated family access to the patient (80%) and family follow-up after patient death (65%) to be important criteria. Fourteen-candidate quality criteria for patient- and family-centered injury care were developed and shown to have content validity. These may be used to guide quality improvement practices.

  14. "Walking in a maze": community providers' difficulties coordinating health care for homeless patients.

    Science.gov (United States)

    LaCoursiere Zucchero, Terri; McDannold, Sarah; McInnes, D Keith

    2016-09-07

    While dual usage of US Department of Veterans Affairs (VA) and non-VA health services increases access to care and choice for veterans, it is also associated with a number of negative consequences including increased morbidity and mortality. Veterans with multiple health conditions, such as the homeless, may be particularly susceptible to the adverse effects of dual use. Homeless veteran dual use is an understudied yet timely topic given the Patient Protection and Affordable Care Act and Veterans Choice Act of 2014, both of which may increase non-VA care for this population. The study purpose was to evaluate homeless veteran dual use of VA and non-VA health care by describing the experiences, perspectives, and recommendations of community providers who care for the population. Three semi-structured focus group interviews were conducted with medical, dental, and behavioral health providers at a large, urban Health Care for the Homeless (HCH) program. Qualitative content analysis procedures were used. HCH providers experienced challenges coordinating care with VA medical centers for their veteran patients. Participants lacked knowledge about the VA health care system and were unable to help their patients navigate it. The HCH and VA medical centers lacked clear lines of communication. Providers could not access the VA medical records of their patients and felt this hampered the quality and efficiency of care veterans received. Substantial challenges exist in coordinating care for homeless veteran dual users. Our findings suggest recommendations related to education, communication, access to electronic medical records, and collaborative partnerships. Without dedicated effort to improve coordination, dual use is likely to exacerbate the fragmented care that is the norm for many homeless persons.

  15. Provider Experiences with Chronic Care Management (CCM) Services and Fees: A Qualitative Research Study.

    Science.gov (United States)

    O'Malley, Ann S; Sarwar, Rumin; Keith, Rosalind; Balke, Patrick; Ma, Sai; McCall, Nancy

    2017-12-01

    Support for ongoing care management and coordination between office visits for patients with multiple chronic conditions has been inadequate. In January 2015, Medicare introduced the Chronic Care Management (CCM) payment policy, which reimburses providers for CCM activities for Medicare beneficiaries occurring outside of office visits. To explore the experiences, facilitators, and challenges of practices providing CCM services, and their implications going forward. Semi-structured telephone interviews from January to April 2016 with 71 respondents. Sixty billing and non-billing providers and practice staff knowledgeable about their practices' CCM services, and 11 professional society representatives. Practice respondents noted that most patients expressed positive views of CCM services. Practice respondents also perceived several patient benefits, including improved adherence to treatment, access to care team members, satisfaction, care continuity, and care coordination. Facilitators of CCM provision included having an in-practice care manager, patient-centered medical home recognition, experience developing care plans, patient trust in their provider, and supplemental insurance to cover CCM copayments. Most billing practices reported few problems obtaining patients' consent for CCM, though providers felt that CMS could better facilitate consent by marketing CCM's goals to beneficiaries. Barriers reported by professional society representatives and by billing and non-billing providers included inadequacy of CCM payments to cover upfront investments for staffing, workflow modification, and time needed to manage complex patients. Other barriers included inadequate infrastructure for health information exchange with other providers and limited electronic health record capabilities for documenting and updating care plans. Practices owned by hospital systems and large medical groups faced greater bureaucracy in implementing CCM than did smaller, independent practices

  16. The experiences of pediatric social workers providing end-of-life care.

    Science.gov (United States)

    Muskat, Barbara; Brownstone, David; Greenblatt, Andrea

    2017-07-01

    Pediatric social workers working in acute care hospital settings may care for children and their families in end-of-life circumstances. This qualitative study is part of a larger study focusing on the experiences of health care providers working with dying children. This study consisted of 9 semi-structured interviews of acute care pediatric social workers who work with dying children and their families. Themes included the role of social work with dying children, the impact of their work and coping strategies. Authors suggest a hospital-worker partnership in supporting staff and promotion of supportive resources.

  17. Efficacy of musculoskeletal injections given by primary care providers in the office

    Directory of Open Access Journals (Sweden)

    Eghbal Eftekhaari T

    2013-09-01

    Full Text Available Tasnim Eghbal Eftekhaari,1 Mirzaali Nazarnezhad,1 Iman Ghasemzadeh2 1Clinical Research Development Unit, Hormozgan University of Medical Sciences Bandar Abbas, Iran; 2Infectious Disease Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, IranPatients commonly present to primary care physicians with musculoskeletal symptoms. Clinicians qualified in internal medicine must be knowledgeable about the diagnosis and management of musculoskeletal diseases, yet they often receive inadequate postgraduate training on this topic. The musculoskeletal problems most frequently encountered in our busy injection practice involve, in decreasing order, the knees, trochanteric bursae, and glenohumeral joints.1 However, patients usually present to a primary care physician and embark on treatment there, despite having the option of referral to a subspecialist fully trained in this procedure.View original paper by Bhagra and colleagues.

  18. Criteria for clinical audit of women friendly care and providers' perception in Malawi

    Directory of Open Access Journals (Sweden)

    van den Broek Nynke

    2008-07-01

    Full Text Available Abstract Background There are two dimensions of quality of maternity care, namely quality of health outcomes and quality as perceived by clients. The feasibility of using clinical audit to assess and improve the quality of maternity care as perceived by women was studied in Malawi. Objective We sought to (a establish standards for women friendly care and (b explore attitudinal barriers which could impede the proper implementation of clinical audit. Methods We used evidence from Malawi national guidelines and World Health Organisation manuals to establish local standards for women friendly care in three districts. We equally conducted a survey of health care providers to explore their attitudes towards criterion based audit. Results The standards addressed different aspects of care given to women in maternity units, namely (i reception, (ii attitudes towards women, (iii respect for culture, (iv respect for women, (v waiting time, (vi enabling environment, (vii provision of information, (viii individualised care, (ix provision of skilled attendance at birth and emergency obstetric care, (x confidentiality, and (xi proper management of patient information. The health providers in Malawi generally held a favourable attitude towards clinical audit: 100.0% (54/54 agreed that criterion based audit will improve the quality of care and 92.6% believed that clinical audit is a good educational tool. However, there are concerns that criterion based audit would create a feeling of blame among providers (35.2%, and that manager would use clinical audit to identify and punish providers who fail to meet standards (27.8%. Conclusion Developing standards of maternity care that are acceptable to, and valued by, women requires consideration of both the research evidence and cultural values. Clinical audit is acceptable to health professionals in Malawi although there are concerns about its negative implications to the providers.

  19. Consumer-providers of care for adult clients of statutory mental health services.

    Science.gov (United States)

    Pitt, Veronica; Lowe, Dianne; Hill, Sophie; Prictor, Megan; Hetrick, Sarah E; Ryan, Rebecca; Berends, Lynda

    2013-03-28

    life, empowerment, function, social relations), client satisfaction with service provision (SMD 0.76, 95% CI -0.59 to 2.10) and with staff (SMD 0.18, 95% CI -0.43 to 0.79), attendance rates (SMD 0.52 (95% CI -0.07 to 1.11), hospital admissions and length of stay, or attrition (risk ratio 1.29, 95% CI 0.72 to 2.31) between groups with consumer-providers as an adjunct to professional-led care and those receiving usual care from health professionals alone. One study found a small difference favouring the intervention group for both client and staff ratings of clients' needs having been met, although detection bias may have affected the latter. None of the six studies in this comparison reported client mental health outcomes.No studies in either comparison group reported data on adverse outcomes for clients, or the financial costs of service provision. Involving consumer-providers in mental health teams results in psychosocial, mental health symptom and service use outcomes for clients that were no better or worse than those achieved by professionals employed in similar roles, particularly for case management services.There is low quality evidence that involving consumer-providers in mental health teams results in a small reduction in clients' use of crisis or emergency services. The nature of the consumer-providers' involvement differs compared to professionals, as do the resources required to support their involvement. The overall quality of the evidence is moderate to low. There is no evidence of harm associated with involving consumer-providers in mental health teams.Future randomised controlled trials of consumer-providers in mental health services should minimise bias through the use of adequate randomisation and concealment of allocation, blinding of outcome assessment where possible, the comprehensive reporting of outcome data, and the avoidance of contamination between treatment groups. Researchers should adhere to SPIRIT and CONSORT reporting standards for

  20. 'right@home': a randomised controlled trial of sustained nurse home visiting from pregnancy to child age 2 years, versus usual care, to improve parent care, parent responsivity and the home learning environment at 2 years.

    Science.gov (United States)

    Goldfeld, Sharon; Price, Anna; Bryson, Hannah; Bruce, Tracey; Mensah, Fiona; Orsini, Francesca; Gold, Lisa; Hiscock, Harriet; Smith, Charlene; Bishop, Lara; Jackson, Dianne; Kemp, Lynn

    2017-03-20

    By the time children start school, inequities in learning, development and health outcomes are already evident. Sustained nurse home visiting (SNHV) offers a potential platform for families experiencing adversity, who often have limited access to services. While SNHV programmes have been growing in popularity in Australia and internationally, it is not known whether they can improve children's learning and development when offered via the Australian service system. The right@home trial aims to investigate the effectiveness of an SNHV programme, offered to women from pregnancy to child age 2 years, in improving parent care of and responsivity to the child, and the home learning environment. Pregnant Australian women (n=722) are identified after completing a screening survey of 10 factors known to predict children's learning and development (eg, young pregnancy, poor mental or physical health, lack of support). Consenting women-surveyed while attending clinics at 10 hospitals in Victoria and Tasmania-are enrolled if they report having 2 or more risk factors. The intervention comprises 25 home visits from pregnancy to 2 years, focusing on parent care of the child, responsivity to the child and providing a good quality home learning environment. The standard, universal, Australian child and family health service provides the comparator (control). Primary outcome measures include a combination of parent-reported and objective assessments of children's sleep, safety, nutrition, parenting styles and the home learning environment, including the Home Observation of the Environment Inventory and items adapted from the Longitudinal Study of Australian Children. This study is approved by the Royal Children's Hospital Human Research Ethics Committees (HREC 32296) and site-specific HRECs. The investigators and sponsor will communicate the trial results to stakeholders, participants, healthcare professionals, the public and other relevant groups via presentations and

  1. HIV health-care providers' burnout: can organizational culture make a difference?

    Science.gov (United States)

    Ginossar, Tamar; Oetzel, John; Hill, Ricky; Avila, Magdalena; Archiopoli, Ashley; Wilcox, Bryan

    2014-01-01

    One of the major challenges facing those working with people living with HIV (PLWH) is the increased potential for burnout, which results in increased turnover and reduces quality of care provided for PLWH. The goal of this study was to examine the relationship among HIV health-care providers' burnout (emotional exhaustion and depersonalization) and organizational culture including teamwork, involvement in decision-making, and critical appraisal. Health-care providers for PLWH (N = 47) in federally funded clinics in a southwestern state completed a cross-sectional survey questionnaire about their perceptions of organizational culture and burnout. The results of multiple regression analysis indicated that positive organizational culture (i.e., teamwork) was negatively related to emotional burnout (p organizational culture (i.e., critical appraisal) was positively related to depersonalization (p organizational communication interventions might protect HIV health-care providers from burnout.

  2. Talking about Complementary and Alternative Medicine with your Health Care Provider: A workbook and tips

    Science.gov (United States)

    A workbook to help patients and doctors talk about the use of complementary and alternative medicine(CAM) during and after cancer care. Worksheets, tips, and resources are provided for patients and doctors to help track CAM use.

  3. Talking about Complementary and Alternative Medicine with Health Care Providers: A Workbook and Tips

    Science.gov (United States)

    A workbook to help patients and doctors talk about the use of complementary and alternative medicine(CAM) during and after cancer care. Worksheets, tips, and resources are provided for patients and doctors to help track CAM use.

  4. Talking about Complementary and Alternative Medicine with Health Care Provider: A Workbook and Tips

    Science.gov (United States)

    A workbook to help patients and doctors talk about the use of complementary and alternative medicine(CAM) during and after cancer care. Worksheets, tips, and resources are provided for patients and doctors to help track CAM use.

  5. Cost Benefit Analysis of Providing Level II Trauma Care at William Beaumont Army Medical Center (WBAMC)

    National Research Council Canada - National Science Library

    Gerepka, Peter

    2002-01-01

    .... During the period from 1 October 2000 to 30 September 2001, WBAMC, a designated Level II trauma center by the American College of Surgeons, provided care for 410 patients of which 181 were civilian emergencies...

  6. Barriers to health education in adolescents: health care providers' perspectives compared to high school adolescents.

    Science.gov (United States)

    Abedian, Kobra; Shahhosseini, Zohreh

    2015-11-01

    Although adolescence is marked by profound and dynamic changes, it is virtually neglected by health care providers, by society, and even by most parents, teachers, and health professionals. The aim of this study was to investigate barriers to health education in adolescents from health care providers' views compared to teens. The study population consisted of 72 health care providers and 402 high school female students in Northern Iran in 2012. They completed a self-administered questionnaire about their views on barriers to adolescents' health education. It is revealed that the major barrier to adolescents' health education from a health care providers' perspective is "Lack of private room for adolescents' health education", while "Lack of adolescents' interest to content of educational programs" is a significantly greater barrier to health education among adolescents. The results suggest that for adolescent health education, specific strategies should be used in adolescent health promotion programs.

  7. Elements of patient-health-care provider communication related to cardiovascular rehabilitation referral.

    Science.gov (United States)

    Pourhabib, Sanam; Chessex, Caroline; Murray, Judy; Grace, Sherry L

    2016-04-01

    Cardiovascular rehabilitation has been designed to decrease the burden of cardiovascular disease. This study described (1) patient-health-care provider interactions regarding cardiovascular rehabilitation and (2) which discussion elements were related to patient referral. This was a prospective study of cardiovascular patients and their health-care providers. Discussion utterances were coded using the Roter Interaction Analysis System. Discussion between 26 health-care providers and 50 patients were recorded. Cardiovascular rehabilitation referral was related to greater health-care provider interactivity (odds ratio = 2.82, 95% confidence interval = 1.01-7.86) and less patient concern and worry (odds ratio = 0.64, 95% confidence interval = 0.45-0.89). Taking time for reciprocal discussion and allaying patient anxiety may promote greater referral. © The Author(s) 2014.

  8. Online social network use by health care providers in a high traffic patient care environment.

    Science.gov (United States)

    Black, Erik; Light, Jennifer; Paradise Black, Nicole; Thompson, Lindsay

    2013-05-17

    The majority of workers, regardless of age or occupational status, report engaging in personal Internet use in the workplace. There is little understanding of the impact that personal Internet use may have on patient care in acute clinical settings. The objective of this study was to investigate the volume of one form of personal Internet use-online social networking (Facebook)-generated by workstations in the emergency department (ED) in contrast to measures of clinical volume and severity. The research team analyzed anonymous network utilization records for 68 workstations located in the emergency medicine department within one academic medical center for 15 consecutive days (12/29/2009 to 1/12/2010). This data was compared to ED work index (EDWIN) data derived by the hospital information systems. Health care workers spent an accumulated 4349 minutes (72.5 hours) browsing Facebook, staff cumulatively visited Facebook 9369 times and spent, on average, 12.0 minutes per hour browsing Facebook. There was a statistically significant difference in the time spent on Facebook according to time of day (19.8 minutes per hour versus 4.3 minutes per hour, P<.001). There was a significant, positive correlation between EDWIN scores and time spent on Facebook (r=.266, P<.001). Facebook use constituted a substantive percentage of staff time during the 15-day observation period. Facebook use increased with increased patient volume and severity within the ED.

  9. An Opportunity for Healing and Holistic Care: Exploring the Roles of Health Care Providers Working Within Northern Canadian Aboriginal Communities.

    Science.gov (United States)

    Rahaman, Zaida; Holmes, Dave; Chartrand, Larry

    2016-05-22

    The purpose of this qualitative study was exploring what the roles and challenges of health care providers working within Northern Canadian Aboriginal communities are and what resources can help support or impede their efforts in working toward addressing health inequities within these communities. The qualitative research conducted was influenced by a postcolonial epistemology. The works of theorists Fanon on colonization and racial construction, Kristeva on semiotics and abjection, and Foucault on power/knowledge, governmentality, and biopower were used in providing a theoretical framework. Critical discourse analysis of 25 semistructured interviews with health care providers was used to gain a better understanding of their roles and challenges while working within Northern Canadian Aboriginal communities. Within this research study, three significant findings emerged from the data. First, the Aboriginal person's identity was constructed in relation to the health care provider's role of delivering essential health services. Second, health care providers were not treating the "ill" patient, but rather treating the patient for being "ill." Third, health care providers were treating the Aboriginal person for being "Aboriginal" by separating the patient from his or her identity. The treatment involved reforming the Aboriginal patient from the condition of being "Aboriginal." © The Author(s) 2016.

  10. Knowledge and practice related to gestational diabetes among primary health care providers in Morocco: Potential for a defragmentation of care?

    Science.gov (United States)

    Utz, Bettina; Assarag, Bouchra; Essolbi, Amina; Barkat, Amina; Delamou, Alexandre; De Brouwere, Vincent

    2017-08-01

    The objective of this study was to assess knowledge and practices of general practitioners, nurses and midwives working at primary health care facilities in Morocco regarding screening and management of gestational diabetes (GDM). Structured interviews with 100 doctors, midwives and nurses at 44 randomly selected public health care centers were conducted in Marrakech and Al Haouz. All data were descriptively analyzed. Ethical approval for the study was granted by the institutional review boards in Belgium and Morocco. Public primary health care providers have a basic understanding of gestational diabetes but screening and management practices are not uniform. Although 56.8% of the doctors had some pre-service training on gestational diabetes, most nurses and midwives lack such training. After diagnosing GDM, 88.5% of providers refer patients to specialists, only 11.5% treat them as outpatients. Updating knowledge and skills of providers through both pre- and in-service-training needs to be supported by uniform national standards enabling first line health care workers to manage women with GDM and thus increase access and provide a continuity in care. Findings of this study will be used to pilot a model of GDM screening and initial management through the primary level of care. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  11. Home Care Providers to the Rescue: A Novel First-Responder Programme.

    Directory of Open Access Journals (Sweden)

    Steen M Hansen

    Full Text Available To describe the implementation of a novel first-responder programme in which home care providers equipped with automated external defibrillators (AEDs were dispatched in parallel with existing emergency medical services in the event of a suspected out-of-hospital cardiac arrest (OHCA.We evaluated a one-year prospective study that trained home care providers in performing cardiopulmonary resuscitation (CPR and using an AED in cases of suspected OHCA. Data were collected from cardiac arrest case files, case files from each provider dispatch and a survey among dispatched providers. The study was conducted in a rural district in Denmark.Home care providers were dispatched to 28 of the 60 OHCAs that occurred in the study period. In ten cases the providers arrived before the ambulance service and subsequently performed CPR. AED analysis was executed in three cases and shock was delivered in one case. For 26 of the 28 cases, the cardiac arrest occurred in a private home. Ninety-five per cent of the providers who had been dispatched to a cardiac arrest reported feeling prepared for managing the initial resuscitation, including use of AED.Home care providers are suited to act as first-responders in predominantly rural and residential districts. Future follow-up will allow further evaluation of home care provider arrivals and patient survival.

  12. Home Care Providers to the Rescue: A Novel First-Responder Programme

    Science.gov (United States)

    Hansen, Steen M.; Brøndum, Stig; Thomas, Grethe; Rasmussen, Susanne R.; Kvist, Birgitte; Christensen, Anette; Lyng, Charlotte; Lindberg, Jan; Lauritsen, Torsten L. B.; Lippert, Freddy K.; Torp-Pedersen, Christian; Hansen, Poul A.

    2015-01-01

    Aim To describe the implementation of a novel first-responder programme in which home care providers equipped with automated external defibrillators (AEDs) were dispatched in parallel with existing emergency medical services in the event of a suspected out-of-hospital cardiac arrest (OHCA). Methods We evaluated a one-year prospective study that trained home care providers in performing cardiopulmonary resuscitation (CPR) and using an AED in cases of suspected OHCA. Data were collected from cardiac arrest case files, case files from each provider dispatch and a survey among dispatched providers. The study was conducted in a rural district in Denmark. Results Home care providers were dispatched to 28 of the 60 OHCAs that occurred in the study period. In ten cases the providers arrived before the ambulance service and subsequently performed CPR. AED analysis was executed in three cases and shock was delivered in one case. For 26 of the 28 cases, the cardiac arrest occurred in a private home. Ninety-five per cent of the providers who had been dispatched to a cardiac arrest reported feeling prepared for managing the initial resuscitation, including use of AED. Conclusion Home care providers are suited to act as first-responders in predominantly rural and residential districts. Future follow-up will allow further evaluation of home care provider arrivals and patient survival. PMID:26509532

  13. What's in a Name? Health Care Providers' Perceptions of Pediatric Pain Patients Based on Diagnostic Labels.

    Science.gov (United States)

    Betsch, Taylor A; Gorodzinsky, Ayala Y; Finley, G A; Sangster, Michael; Chorney, Jill

    2017-08-01

    Diagnostic labels can help patients better understand their symptoms and can influence providers' treatment planning and patient interactions. Recurrent pain is common in childhood; however, there are various diagnostic labels used. The objective of this study was to evaluate the influence of diagnostic labels on pediatric health care providers' perceptions of pediatric chronic pain patients. Using an online survey, providers were randomly assigned to 1 of 2 vignette conditions (differing only in diagnostic label provided) and completed questionnaires about their perceptions of the vignette patient. Responses from 58 participants were analyzed. The 2 groups, based on diagnostic conditions used (fibromyalgia and chronic widespread pain) did not differ significantly on general demographics and health care providers' perceptions of the patient. Perceived origin of the pain influenced providers' perceptions; pain of a perceived medical origin was negatively correlated with stigmatization and positively correlated with sympathy. Perceived psychological origin was positively correlated with stigmatization and providers' age. Health care providers' perceptions of children's pain are more likely influenced by the presumed etiology rather than the diagnostic label used. Pain believed to be more medically based was associated with more positive reactions from providers (ie, less stigmatization). Older providers in particular perceived the patient more negatively if they believe the pain to be psychologically based. The findings of this pediatric study replicated findings from adult literature on chronic pain, suggesting that children and adults are subject to negative perceptions from health care providers when the providers believe the pain to be psychological in origin.

  14. Pediatric Emergency Department and Primary Care Provider Attitudes on Assessing Childhood Adversity.

    Science.gov (United States)

    Schilling, Samantha; Murray, Ashlee; Mollen, Cynthia J; Wedin, Tara; Fein, Joel A; Scribano, Philip V

    2017-07-03

    The purpose of this study was to understand pediatric emergency department (ED) and primary care (PC) health care provider attitudes and beliefs regarding the intersection between childhood adversities and health care. We conducted in-depth, semistructured interviews in 2 settings (ED and PC) within an urban health care system. Purposive sampling was used to balance the sample among 3 health care provider roles. Interview questions were based on a modified health beliefs model exploring the "readiness to act" among providers. Interviews were recorded, transcribed, and coded. Interviews continued until theme saturation was reached. Saturation was achieved after 26 ED and 19 PC interviews. Emergency department/primary care providers were similar in their perception of patient susceptibility to childhood adversity. Childhood mental health problems were the most frequently referenced adverse outcome, followed by poor childhood physical health. Adult health outcomes because of childhood adversity were rarely mentioned. Many providers felt that knowing about childhood adversity in the medical setting was important because it relates to provision of tangible resources. There were mixed opinions about whether or not pediatric health care providers should be identifying childhood adversities at all. Although providers exhibited knowledge about childhood adversity, the perceived effect on health was only immediate and tangible. The effect of childhood adversity on lifelong health and the responsibility and potential accountability health systems have in addressing these important health determinants was not recognized by many respondents in our study. Addressing these provider perspectives will be a critical component of successful transformation toward more accountable health care delivery systems.

  15. Ebola: Emergency preparedness and perceived response of Malaysian health care providers.

    Science.gov (United States)

    Rajiah, Kingston; Maharajan, Mari Kannan; Binti Samsudin, Sarah Zakiah; Tan, Choo Lin; Tan Yen Pei, Adeline; Wong San Ying, Audrey

    2016-12-01

    We studied the emergency preparedness and perceived response for Ebola virus disease among various health care providers in Malaysia using a self-report questionnaire. Most of the health care providers felt that they were able to respond to Ebola virus disease and were aware of the level of preparedness needed during emergency. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  16. Counteracting Animal Homelessness and Providing Care for Stray Animals as a Task of a Commune

    OpenAIRE

    Szalewska, Małgorzata

    2017-01-01

    The analysis of Polish binding law acts allows one to assume that, on normative level, the obligation of public administration to provide care for stray animals is deeply embedded. Both the Animal Protection Act, as well as the Act on Maintaining Cleanliness, indicate the tasks of a commune in the scope of providing care for stray animals, catching homeless animals and counteracting their homelessness. Simultaneously, the analysis of jurisdiction, and inquiries as well as considerations emerg...