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Objective:To systematically evaluate the quality of continuing care services carried out by nursing staff in China, comprehensively integrate the influencing factors of continuing care services, and provide guidance for promoting the development of continuing care in China.Methods:PubMed, EMbase, Web of Science, the Cochrane Library, CMB, SinoMed, CINAHL, CNKI, Wanfang Data and VIP related qualitative studies were searched from the database establishment to March 2022. The NoteExpress software was used to screen and analyze the literature, the 2017 Australian JBI Evidence-based Health Care Center quality research quality evaluation standard was used to conduct qualitative evaluation of the literature, and the Meta-integration method was adopted to carry out pooled integration. The ConQual approach was used to evaluate the quality of the integrated results.Results:A total of 39 results were extracted from 11 studies. Eleven new categories were summarized and four integrated results were obtained, which were: nurses lack relevant cognitive, motivational and behavioral skills; patients have poor compliance and low trust in medical prescriptions; lack of team management, method guidance and system standards; lack of connection sharing, input supply and upper protection. The total evidential quality of the integration results was intermediate.Conclusions:At present, nurses should strengthen their own ability, pay attention to patient education, enhance the sense of trust between doctors and patients. Managers should pay attention to team building, standardize the service standards and systems. The state should increase input, improve social policy support and legal protection; for the orderly development of continuity of care services escort.
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Introducción: El intento suicida es uno de los factores de riesgo suicida más relevantes, conocer variables asociadas y estrategias de seguimiento post-intento suicida contribuye a prevenir el suicidio. Objetivos: el objetivo de este trabajo fue describir características clínico-sociodemográfica de las personas que presentan intento de suicidio, y dar a conocer una estrategia de vigilancia clínicoepidemiológica que se activa posterior al intento suicida. Método: Se utilizó un diseño transversal, participaron 170 personas de 15 y más años ingresados a la Unidad para Personas con Intento suicida entre los años 2015 al 2018 en la Región De Los Ríos, Chile. Se evaluaron estadísticamente datos de carácter sociodemográfico y clínicos, previos y posterior al intento suicida. Resultado: Los resultados sociodemográficos muestran predominancia de intentos de mujeres, con una muestra que tiene su lugar de residencia principalmente en sectores urbanos. Además, se observó que la pertenencia religiosa católica o evangélica, podría asociarse a mayor riesgo de reintento suicida (p=0,014). Conclusiones: Los factores clínicos muestran que presentar intentos suicidas previos, depresión en curso al momento del intento suicida y los conflictos de pareja son factores relevantes a considerar. La frecuencia de suicidio y los reintentos suicida en vigilancia fue baja, por lo que fortalecer la continuidad de cuidados podría tener un rol preventivo en el fenómeno suicida.
Introduction: Suicidal attempt is one of the most relevant suicide risk factors, knowing associated variables and post-suicide attempt follow-up strategies contributes to preventing suicide. Objective: the objective of this work was to describe the clinical-sociodemographic characteristics of people who present a suicide attempt, and to present a strategy of clinical-epidemiological surveillance that is activated after the suicide attempt. Methods: A cross-sectional design was carried out, involving 170 subjects aged 15 and over admitted to the Unit for People with a suicide attempt between 2015 and 2018 in the Los Ríos region, Chile. Sociodemographic and clinical data, before and after the suicide attempt, were statistically evaluated. Results: The sociodemographic results show a predominance of attempts by women, with a sample that has its place of residence mainly in urban areas. In addition, it was observed that Catholic or evangelical religious affiliation could be associated with a higher risk of suicidal retry (p = 0.014). Conclusions: The clinical factors show that having previous suicide attempts, ongoing depression at the time of the suicide attempt, and partner conflicts are relevant factors to consider. The frequency of suicide and suicide retries in surveillance was low, so strengthening the continuity of care could play a preventive role in the suicide phenomenon.
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A longitudinalidade do cuidado possibilita a criação de uma conexão de confiança entre usuários e profissionais, o que facilita a comunicação efetiva e uma compreensão mais completa das necessidades e do histórico de saúde de cada pessoa. Este estudo tem como objetivo refletir sobre a importância da longitudinalidade na APS, discutindo seus benefícios, desafios e perspectivas. Trata-se de um estudo reflexivo, realizado entre março e maio de 2023, fundamentado na formulação discursiva da importância da longitudinalidade na APS que visou explorar as tendências, desafios e perspectivas associados a esse aspecto crucial do cuidado ao longo do tempo. O texto está apresentado em três partes de acordo com os pontos de reflexão. Uma revisão da literatura foi realizada para reunir evidências e análises relacionadas à longitudinalidade na APS, abordando seus benefícios, obstáculos e possíveis soluções. Os resultados apontam para a longitudinalidade, como aspecto crucial da APS na promoção da saúde e prevenção de doenças ao longo do tempo. Estes destacam a necessidade de fortalecer a longitudinalidade na APS, considerando o impacto positivo que isso pode ter na saúde da população uma vez que essa relação fortalece a qualidade do cuidado, a adesão ao tratamento e a satisfação do usuário.
Longitudinal care enables the creation of a trusting connection between users and professionals, which facilitates effective communication and a more complete understanding of each person's needs and health history. This study aims to reflect on the importance of longitudinality in PHC, discussing its benefits, challenges and perspectives. This is a reflective study, carried out between March and May 2023, based on the discursive formulation of the importance of longitudinality in PHC, which aimed to explore the trends, challenges and perspectives associated with this crucial aspect of care over time. The text is presented in three parts according to the points of reflection. A literature review was carried out to gather evidence and analyzes related to longitudinality in PHC, addressing its benefits, obstacles and possible solutions. The results point to longitudinality, as a crucial aspect of PHC in health promotion and disease prevention over time. These highlight the need to strengthen longitudinality in PHC, considering the positive impact that this can have on the population's health, since this relationship strengthens the quality of care, adherence to treatment and user satisfaction.
La atención longitudinal permite crear una conexión de confianza entre usuarios y profesionales, lo que facilita una comunicación eficaz y una comprensión más completa de las necesidades y el historial de salud de cada persona. Este estudio tiene como objetivo reflexionar sobre la importancia de la longitudinalidad en la APS, discutiendo sus beneficios, desafíos y perspectivas. Se trata de un estudio reflexivo, realizado entre marzo y mayo de 2023, a partir de la formulación discursiva de la importancia de la longitudinalidad en la APS, que tuvo como objetivo explorar las tendencias, desafíos y perspectivas asociadas a este aspecto crucial del cuidado a lo largo del tiempo. El texto se presenta en tres partes según los puntos de reflexión. Se realizó una revisión de la literatura para recopilar evidencias y análisis relacionados con la longitudinalidad en la APS, abordando sus beneficios, obstáculos y posibles soluciones. Los resultados apuntan a la longitudinalidad, como un aspecto crucial de la APS en la promoción de la salud y la prevención de enfermedades a lo largo del tiempo. Estos resaltan la necesidad de fortalecer la longitudinalidad en la APS, considerando el impacto positivo que esta puede tener en la salud de la población, ya que esa relación fortalece la calidad de la atención, la adherencia al tratamiento y la satisfacción del usuario.
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En Chile, el 70% de la población de 15 años y más vive con multimorbilidad, es decir, con la presencia de dos o más condiciones crónicas de forma simultánea. El abordaje clásico de la cronicidad por programas en atención primaria de salud, con foco en la enfermedad, se expresa en cuidados fragmentados, ineficaces y muy alejados de los principios de centralidad en la persona, integralidad y continuidad del cuidado impulsados desde el modelo de atención integral de salud familiar y comunitario (MAIS). La estrategia de cuidado integral centrado en las personas para la promoción, prevención y manejo de la cronicidad en contexto de multimorbilidad (ECICEP), se constituye en una respuesta a esta problemática.La multimorbilidad representa un desafío de gran envergadura en el rediseño desde una atención fragmentada hacia el cuidado integral centrado en la persona. Implica un proceso de gestión del cambio, en donde es necesario sensibilizar en la urgencia y sentido del cambio, estratificar a la población según riesgo, capacitar a los equipos de salud, reorganizar los procesos administrativos (agendamiento, registro clínico) y clínicos (ingreso y control integral, planes de cuidado consensuados, gestión del cuidado, seguimiento a distancia, automanejo), así como favorecer el liderazgo y acompañamiento del cambio y el trabajo colaborativo en red.Este proceso requiere voluntad política, con sentido de urgencia del cambio y gradualidad, para que su instalación sea eficiente y respetuosa. Por ello, se inicia el proceso con las personas de alta complejidad, que son quienes tienen más riesgo de hospitalizaciones evitables y otras complicaciones
In Chile, 70% of the population aged 15 years and over lives with multimorbidity, that is, with the presence of two or more chronic conditions simultaneously. The classic approach to chronicity by programs in primary health care, with a focus on the disease, is expressed in fragmented care, ineffective and far removed from the principles of person-centeredness, comprehensiveness and continuity of care promoted by the Comprehensive Family and Community Health Care Model (MAIS). The People-Centered Integrated Care Strategy for the Promotion, Prevention and Management of Chronicity in the Context of Multimorbidity (ECICEP) is a response to this problem. Chronic multimorbidity represents a major challenge in the redesign from fragmented care to comprehensive person-centered care. It implies a process of change management, in which it is necessary to raise awareness of the urgency and sense of change, stratify the population according to risk, train health teams, reorganize administrative (scheduling, clinical records) and clinical processes (admission and comprehensive control, consensual care plans, care management, remote follow-up, self-management), as well as promoting leadership and accompaniment of change, networking and intersectoral coordination. This process requires political will, with a sense of urgency of change and gradualness, so that its installation is efficient and respectful. For this reason, the process begins with highly complex patients, who are at the greatest risk of avoidable hospitalizations and other complications.
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Humans , Patient-Centered Care , Comprehensive Health Care , Multimorbidity , Primary Health Care , Chronic Disease , Continuity of Patient Care , Self-Management , Change ManagementABSTRACT
@#Schizophrenia is a complex mental health disorder that has a huge burden on the individual’s physical health. Despite its low prevalence, the disorder has been listed among the top ten contributors of health burden and disability around the world. People with schizophrenia usually suffer from a myriad of physical health conditions with 33 percent of the patients having three or more physical health problems. Schizophrenia has been linked with up to threefold increased risk of cardiovascular mortality. Risk factors such as metabolic disorders and lifestyle behaviours are the major contributors to cardiovascular-related diseases (CVD). Treatment of schizophrenia and its comorbid physical conditions often presents a challenge to health care professionals and caregivers due to the presence of multiple psychological and physical disabilities. However, with appropriate intervention at early onset, the likelihood of recovery will be highest. Primary care professionals are often the stable point of consultation for patients to seek help in the community. The partnership between the patient and primary care professionals is paramount in optimal management and continuity of care for schizophrenia patients with chronic physical illness.
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RESUMEN Las personas con diabetes mellitus tipo 2 infectadas por SARS-CoV-2 tienen mayores riesgos de desarrollar COVID-19 con complicaciones y de morir como consecuencia de ella. La diabetes es una condición crónica en la que se requiere continuidad de cuidados que implican un contacto con los establecimientos de salud, pues deben tener acceso regular a medicamentos, exámenes y citas con personal de salud. Esta continuidad de cuidados se ha visto afectada en el Perú a raíz de la declaratoria del estado de emergencia nacional, producto de la pandemia por la COVID-19 pues muchos establecimientos de salud han suspendido las consultas externas. Este artículo describe algunas estrategias que han desarrollado los diferentes proveedores de salud peruanos en el marco de la pandemia para proveer continuidad del cuidado a las personas con diabetes y finalmente brinda recomendaciones para que reciban los cuidados que necesitan a través del fortalecimiento del primer nivel de atención, como el punto de contacto más cercano con las personas con diabetes.
ABSTRACT Patients diagnosed with type 2 diabetes mellitus, who then become infected with SARS-CoV-2, are at greater risk of developing complications from COVID-19, which may even lead to death. Diabetes is a chronic condition that requires continuous contact with healthcare facilities; therefore, this type of patients should have regular access to medicines, tests and appointments with healthcare personnel. In Peru, care and treatment continuity have been affected since the national state of emergency due to COVID-19 began; because many healthcare facilities suspended outpatient consultations. The strategies presented in this study were developed by different Peruvian health providers in the pandemic context to ensure care continuity for people with diabetes. This article provides recommendations to strengthen primary healthcare, because it is the first level of healthcare contact for patients with diabetes.
Subject(s)
Humans , Male , Female , Patients , Continuity of Patient Care , Diabetes Mellitus , COVID-19 , Primary Health Care , Chronic Disease , Health Personnel , Diabetes Mellitus, Type 2 , Emergencies , SARS-CoV-2ABSTRACT
@#Schizophrenia is a complex mental health disorder that has a huge burden on the individual’s physical health. Despite its low prevalence, the disorder has been listed among the top ten contributors of health burden and disability around the world. People with schizophrenia usually suffer from a myriad of physical health conditions with 33 percent of the patients having three or more physical health problems. Schizophrenia has been linked with up to threefold increased risk of cardiovascular mortality. Risk factors such as metabolic disorders and lifestyle behaviours are the major contributors to cardiovascular-related diseases (CVD). Treatment of schizophrenia and its comorbid physical conditions often presents a challenge to health care professionals and caregivers due to the presence of multiple psychological and physical disabilities. However, with appropriate intervention at early onset, the likelihood of recovery will be highest. Primary care professionals are often the stable point of consultation for patients to seek help in the community. The partnership between the patient and primary care professionals is paramount in optimal management and continuity of care for schizophrenia patients with chronic physical illness.
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BACKGROUND: Diabetes is known as one of the most important ambulatory care sensitive conditions. This study purposed to assess the status of continuity of care (COC) and diabetes-related avoidable hospitalizations (DRAHs) of a group of middle- and old-aged patients and to observe the relationship of the two elements by the two age groups. METHODS: This study utilized the National Health Insurance Service's National Sample Cohort data and the subjects are diabetes patients of 45 and over, classified into two groups of ‘middle-aged’(45–64 years) and ‘old-aged’(≥65 years) patients. The dependent variable was DRAHs, which was defined in accordance with the definition of the Organization for Economic Cooperation and Development “Health Care Quality Indicators” project. COC, as an independent variable, is measured by the COC index in this study. Two-part model (multi-variate and multi-level analyses) was utilized. RESULTS: Factors associated with the status and the number of DRAHs differed by each age group. Meanwhile, the two-part model showed that higher COC was associated with a lower risk of preventable hospitalizations in both middle- and old-aged groups. CONCLUSION: Study findings can provide health policy insights and implications in order to strengthen the primary care system for further improvement of diabetes management, especially for middle- and old-aged groups.
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Humans , Ambulatory Care , Cohort Studies , Continuity of Patient Care , Health Policy , Hospitalization , National Health Programs , Organisation for Economic Co-Operation and Development , Primary Health CareABSTRACT
Continuity of care is one of the core attributes of primary care, which interacts with first-contact, accessibility, coordination and comprehensiveness in a mutual, supportive, and strengthening way to form an interactive mechanism of primary care.This paper first reviews the current literature on definitions and concepts of continuity of care, ascertain the key elements of continuity, and pinpoint the relationship between the dominant and recessive elements.Then, it defines the connotations of continuity of care and their boundaries in the context of primary care, according to the principles of controllability, exhaustion and exclusiveness.Finally it conceptualizes the primary care continuity to lay the foundation for further studies on operationally defining the primary care attributes of general practice.
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O objetivo geral deste estudo foi analisar o processo de desospitalização em um hospital público geral de Minas Gerais - MG na perspectiva de diretores,profissionais de saúde, usuário e sua família. Trata-se de estudo descritivo exploratório,utilizando a abordagem qualitativa, com orientação teórica metodológica da dialética. Os participantes: dois diretores, 10 enfermeiros, dois assistentes sociais, oito médicos e dois coordenadores da linha de cuidado vinculados à assistência na clínica médica em hospital público de ensino de médio porte em Belo Horizonte - BH. Os diretores foram entrevistados para verificar a política e as estratégias que o hospital utiliza para a desospitalização e como é a relação deste com a Rede de Atenção à Saúde (RAS). Os enfermeiros, assistentes sociais e médicos são responsáveis pelo processo dedesospitalização e foram entrevistados para identificar como se aplicam os mecanismos de desospitalização existentes no hospital. Também foram participantes 15 familiares de usuários em processo de desospitalização com a indicação para a continuidade do cuidado no Serviço de Atenção Domiciliar (SAD)em BH. Esses familiares foram entrevistados para identificar os atravessamentose potencialidades no processo de desospitalização. O trabalho de campo iniciou-se em 2015 na clínica médica do hospital, que recebe usuários provenientes da clínica cirúrgica, neurológica e pronto-socorro. Os dados foram coletados pelo pesquisador por meio de entrevista com auxílio de um roteiro semiestruturado, audiogravada, permitindo a identificação das interpretações emitidas sobre adesospitalização e a expectativa do cuidado no domicílio. No diário de campo foram registradas as observações após o trabalho de campo. A análise dos dados foi sustentada pela análise de conteúdo temática na perspectiva...
The aim of the present study was to analyse the process of de-hospitalization at apublic general hospital in the state of Minas Gerais from the perspective of managers, health professionals, service users and their families. This is a descriptive exploratory qualitative study using a dialectical methodology. Study participants were two directors, ten nurses, two social workers, eight doctors and two health care coordinators working at the clinical care unit of a public medium sized teaching hospital in the city of Belo Horizonte. Interviews to directors aimedat identifying the hospitals policies and strategies for de-hospitalization and their relationship with the Health Care System (RAS). Nurses, social workers and doctors are responsible for the process and the interviews carried out with them aimed at recognising how existing de-hospitalization procedures were applied. Fifteen relatives of users in the process of being de-hospitalized and referred to take part in a continuity of care programme through the Home Care Service (SAD) also participated in the study. The objective of the interviews with this group was to assess both the obstacles to the process of de-hospital...
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Humans , Continuity of Patient Care , Deinstitutionalization , Home Care Services, Hospital-Based , Interviews as Topic , Surveys and QuestionnairesABSTRACT
Objective To investigate the application of extended nursing in patients with esophageal carcinoma . Methods 70 cases of patients with esophageal cancer from March 2015 to June 2016 in our hospital as the research object , according to the different nursing methods , 70 patients were randomly divided into control group and observation group , and the control group was given routine nursing , the observation group based on routine on the increase of nursing continuing nurs -ing care, nursing intervention after 6 months, compared two groups of patients with clinical effect .Results The patients in the observation group were better than the control group on health knowledge ;The complication rate of observation group was 34.3%, and the control group and the complication rate was 80%.The complication rate of the observation group was less than the control group;The observation group self care ability is better than the control group;The observation group satisfac-tion 94.3%;The control group satisfaction 65.7%, and the nursing satisfaction in the observation group are better than the control group;Two groups had significant differences , with statistical significance (P<0.05).Conclusion The continuous nursing intervention can effectively improve patients with esophageal carcinoma after discharge of quality of life , improve the self nursing ability of patients , reduce the incidence of complications , improve nursing satisfaction , which is conducive to the rehabilitation of patients , and is worthy of clinical application .
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OBJECTIVES: The goal of this study was to identify association between the continuity of ambulatory care of diabetes patients in South Korea (hereafter Korea) and the incidence of macrovascular complications of diabetes, using claims data compiled by the National Health Insurance Services of Korea. METHODS: This study was conducted retrospectively. The subjects of the study were 43 002 patients diagnosed with diabetes in 2007, who were over 30 years of age, and had insurance claim data from 2008. The macrovascular complications of diabetes mellitus were limited to ischemic heart disease and ischemic stroke. We compared the characteristics of the patients in whom macrovascular complications occurred from 2009 to 2012 to the characteristics of the patients who had no such complications. Multiple logistic regression was used to assess the effects of continuity of ambulatory care on diabetic macrovascular complications. The continuity of ambulatory diabetes care was estimated by metrics such as the medication possession ratio, the quarterly continuity of care and the number of clinics that were visited. RESULTS: Patients with macrovascular complications showed statistically significant differences regarding sex, age, comorbidities, hypertension, dyslipidemia and continuity of ambulatory diabetes care. Visiting a lower number of clinics reduced the odds ratio for macrovascular complications of diabetes. A medication possession ratio below 80% was associated with an increased odds ratio for macrovascular complications, but this result was of borderline statistical significance. CONCLUSIONS: Diabetes care by regular health care providers was found to be associated with a lower occurrence of diabetic macrovascular complications. This result has policy implications for the Korean health care system, in which the delivery system does not work properly.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Ambulatory Care , Diabetes Complications , Diabetes Mellitus/diagnosis , Dyslipidemias/complications , Heart Diseases/epidemiology , Hypertension/complications , Incidence , Insurance Claim Reporting , Logistic Models , Odds Ratio , Republic of Korea/epidemiology , Retrospective Studies , Risk Factors , Stroke/epidemiologyABSTRACT
Objective To translate the English version of Diabetes Continuity of Care Scale (DCCS) into Chinese and to test the reliability and validity of the Chinese version of DCCS in diabetes mellitus patients.Methods Totally 245 patients with diabetes mellitus were recruited and were investigated by the Chinese version of DCCS.Results The internal consistency coefficient of the Chinese version of DCCS ranged from 0.728 to 0.942,which was ＞0.70;split half coefficient r=0.784,and the test-retest was 0.864 while which of each dimension ranged from 0.785 to 0.886.The content validity index was 0.934.Factor analysis got five factors,which explained 76.574％ of the total variance;the factor loading of each item was ＞0.4.Conclusions The Chinese version of DCCS has been proved to be reliable and valid.It can be used as a valid tool for the measurement of continuity of care in patients with diabetes mellitus.
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Objective To translate the English version of Heart Continuity of Care Questionnaire (HCCQ) into Chinese and to test the reliability and validity of the Chinese version of HCCQ in congestive heart failure (CHF) patients and atrial fibrillation (AF).Methods Totally 339 patients with CHF (n=170) and AF (n=169) were recruited and were investigated by the Chinese version of HCCQ.Results The internal consistency coefficient of the Chinese version of HCCQ ranged from 0.821 to 0.913,both above 0.7.The split half coefficient was 0.649,and test-retest reliability was 0.812,which demonstrated better internal consistency.The content validity index was 0.940.Factor analysis got three factors,which explain 47.059％ of the total variance.Conclusions The Chinese version of HCCQ has been proved to be reliable and valid.It can be used as a valid tool for the measurement of heart continuity in cardiac patients.
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Objective To explore the opportunities and challenges which COC (continuity of care) has been facing,some strategies were proposed and improved continuously during the process of deepening medical reform in public hospital,and at the same time to supply reference for government to make relative policy.Methods By SWOT-analysis,the strengths,weaknesses,opportunities as well as threats of COC in medical reform were analyzed comprehensively.Results Depending on national relevant policies,supportive measures,the cooperation from multidisciplinary team was improved.Along with strategies of strengthening advantages,weakening disadvantages,meeting challenges and facing up to threat.COC had be approved and consented initially.Conclusions Public hospitals should demonstrate their various resources and make full use of their advantages,then guide and solid grass-roots in the new healthcare system which integrate medical,rehabilitation and elderly nursing out of the hospital.It must benefit the hospital,specialized subject,family and society.
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Transitions of care occur each time a patient moves from one healthcare provider or care setting to another. Challenges that have been identified include: failure of the patient to keep appointments for outpatient chronic care; inability for smooth transfer of information between various healthcare providers; and failure to find appropriate placement for patients who can no longer manage independent living. As pharmacists representing an array of practice settings, these authors here present the models of contributions made by pharmacy services within such multifaceted approaches. An initial literature search was conducted using the National Library of Medicine via PubMed. Studies conducted in the United States that included at least one pharmacy service within the methods of intervention were selected for review. Where there are published findings from each setting, we include the measured impact, if reported. Although pharmacists represent the most skilled healthcare professionals in medication reconciliation and management, the best processes for tapping that expertise have yet to be fully elucidated. We present this review of current practices with the continued hope that the pharmacy profession will, not only continue to be the quiet patient advocate for best medication use, but also to open our minds to the need to measure, adjust, and measure again, the systems and processes we use to best integrate our knowledge for the overall benefit of the patient.
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Transitions of care occur each time a patient moves from one healthcare provider or care setting to another. Challenges that have been identified include: failure of the patient to keep appointments for outpatient chronic care; inability for smooth transfer of information between various healthcare providers; and failure to find appropriate placement for patients who can no longer manage independent living. As pharmacists representing an array of practice settings, these authors here present the models of contributions made by pharmacy services within such multifaceted approaches. An initial literature search was conducted using the National Library of Medicine via PubMed. Studies conducted in the United States that included at least one pharmacy service within the methods of intervention were selected for review. Where there are published findings from each setting, we include the measured impact, if reported. Although pharmacists represent the most skilled healthcare professionals in medication reconciliation and management, the best processes for tapping that expertise have yet to be fully elucidated. We present this review of current practices with the continued hope that the pharmacy profession will, not only continue to be the quiet patient advocate for best medication use, but also to open our minds to the need to measure, adjust, and measure again, the systems and processes we use to best integrate our knowledge for the overall benefit of the patient.
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A criança egressa da unidade de terapia intensiva, que apresenta condição crônica de saúde, necessita de acompanhamento durante a infância e requer cuidados especiais que são realizados pela família em conjunto com a rede social. Pressupomos que o suporte familiar é aquele que assegura, em primeira instância, a integralidade e a continuidade do cuidado e não se conhece de forma sistematizada, como as práticas de cuidado se dão em relação à condição crônica e de que maneira a família se organiza para isso. Diante disso, este estudo teve como objetivo geral analisar a organização familiar para o cuidado à criança em condição crônica egressa da unidade de terapia intensiva neonatal. Os objetivos específicos consistem em verificar as implicações do cuidado à criança em condição crônica na dinâmica familiar e levantar os desafios determinados pela condição crônica aos cuidadores. O trabalho é de natureza qualitativa e foi orientado pela abordagem teórica da dialética. Os sujeitos do estudo foram famílias de 12 crianças egressas da UTIN do Hospital Sofia Feldman, com condição crônica de saúde e o cenário do estudo foi o domicílio dessas crianças. A coleta de dados foi dividida em três fases. A fase I, realizada a partir da análise documental dos prontuários de crianças egressas da UTIN, momento em que as crianças foram identificadas. A coleta de dados da fase II deu-se por meio da aplicação do QuICCC-R (Questionnaire for Identifying Children with Chronic Conditions - Revised) e a fase III, consistiu na construção do genograma e do ecomapa e de entrevista fundamentada no Modelo Teórico Family Management Style Framework-FMSF, com os familiares das crianças incluídas no estudo. O diário de campo foi utilizado como instrumento de registro da pesquisadora. A análise dos dados foi realizada conforme a técnica de Análise de Conteúdo proposta por Bardin (2008). A partir dos discursos, foram reveladas as seguintes categorias: (1) A chegada da criança...
The child coming from the neonatal intensive care unit, who has chronic health condition, requires accompaniment during infancy and needs special care that are held by the family in conjunction with the social network. We presuppose that family support is one which ensures, in the first instance, integrality and continuity of care and it is not known, in a systematic way, how care practices take place in relation to chronic condition and how the family organizes itself to this. Given this, the general objective of this work is to analyze the family organization to take care of the child in chronic condition who is coming from the neonatal intensive care unit. The specific objectives are to study the implications in the family dynamics because of taking care of a child in chronic condition and to point out challenges determined by chronic condition to caregivers. The study is qualitative and was guided by theoretical approach of dialectics. The study subjects were 12 families of children discharged from NICU of Sofia Feldman Hospital with a chronic health condition and the setting was the home of these children. Data collection was divided into three phases. Phase I, conducted from documentary analysis of medical records of children discharged from the NICU, when the children were identified. The data collection of phase II occurred through the application of QuICCC-R (Questionnaire for Identifying Children with Chronic Conditions - Revised) and phase III consisted of the construction of the genogram and eco-map and interview based on the Theoretical Model Management Family StyleFramework-FMSF with the families of the children included in the study. The field diary was used as an instrument to records of the researcher. Data analysis was performed according to the technique of Content Analysis proposed by Bardin (2008). From the speeches, were revealed the following categories: (1) The arrival of a child: pregnancy, birth and early care; (2) knowledge...
Subject(s)
Humans , Chronic Disease , Family/psychology , Family Health , Surveys and Questionnaires , Qualitative Research , Intensive Care Units, NeonatalABSTRACT
A Reforma Psiquiátrica Brasileira propõe um modelo de atenção baseado na implantação de uma rede comunitária no qual os Centros de Atenção Psicossocial (CAPS) detêm papel fundamental. Neste artigo são apresentados os resultados do estudo piloto que visou adaptar para o contexto brasileiro a "Critical Time Intervention" (CTI) e testar sua viabilidade com pessoas com transtornos do espetro esquizofrênico em tratamento nos CAPS do município do Rio de Janeiro. O desenho da pesquisa incluiu três fases inter-relacionadas. A primeira consistiu em trabalho de campo qualitativo e quantitativo. Esta fase incluiu o mapeamento das características sociodemográficas, clínicas e de utilização de serviços dos usuários dos CAPS, bem como conhecer as necessidades concretas dos participantes do estudo. A segunda fase consistiu na tradução do manual clinico da CTI para incluir as adaptações feitas para o seu uso no Brasil, oriundas dos dados coletados na primeira fase, bem como o treinamento de profissionais de nível médio para atuarem como agenciadores da CTI. A terceira fase consistiu na implementação da intervenção adaptada em um grupo de pacientes com transtornos do espectro esquizofrênicos matriculados nos CAPS, mas com dificuldade de se inserir no tratamento.
Brazilian Psychiatric Reform proposes a mental healthcare model based on the implementation of a community-based service network, in which Psychosocial Service Centers (CAPS) play a fundamental role. The report presents the results of a pilot study which aimed to adapt Critical Time Intervention to the Brazilian context, and to test its feasibility to provide it to persons with schizophrenic spectrum disorders who are enrolled in CAPS of Rio de Janeiro. Methods: The research design included three inter-related phases. Phase one consisted in carrying out qualitative and quantitative field work. This phase included mapping out the socio-demographic, clinical and service utilization data of CAPS users, as well as assessing the mental health needs of participants in the study. The second phase consisted in translation of the CTI clinical manual to include the adaptations made for use in Brazil, which were based on data collected in the first phase, as well as training individuals with moderate education as CTI intervention workers. The third phase consisted of pilot implementation of the adapted intervention among a group of individuals with schizophrenia spectrum disorders enrolled in CAPS, but with difficulties in being included in treatment.
Subject(s)
Humans , Crisis Intervention/organization & administration , Social Work, Psychiatric/organization & administration , Brazil , Crisis Intervention/standards , Pilot Projects , Time FactorsABSTRACT
A longitudinalidade, que trata do acompanhamento do paciente ao longo do tempo por profissionais da equipe de atenção primária em saúde (APS), é considerada característica central deste nível assistencial. O atendimento a este atributo está relacionado com resultados positivos, o que justifica sua utilização para fins de avaliação da APS. Por outro lado, o termo não é usual entre os autores brasileiros, e na literatura internacional o termo continuidade do cuidado é utilizado com sentido semelhante. O presente estudo consiste em revisão conceitual sobre a longitudinalidade/continuidade do cuidado, bem como a identificação de suas dimensões, de forma a favorecer a avaliação do atendimento ao referido atributo. Como resultado, destaca-se a semelhança entre os termos, embora as dimensões identificadas para o atributo não sejam totalmente coincidentes. A revisão permitiu a adoção de três dimensões em acordo com o contexto do sistema de saúde público brasileiro: identificação da unidade básica como fonte regular de cuidado, vínculo terapêutico duradouro e continuidade informacional. A proposta de variáveis para a avaliação da APS aqui apresentada vai ao encontro dessas dimensões.
Longitudinality, which is concerned with Primary Health Care (APS) professionals accompanying patients over time, is considered a central feature of this level of health care. The fulfilment of this attribute is related to positive health results, which justify its use for assessing Primary Health Care. On the other hand, the term is not commonly used by Brazilian authors, and in international literature the term "continuity of care" is used with a similar meaning. Therefore, this study is composed of a conceptual revision of longitudinality/continuity of care, as well as the identification of its dimensions so as to enable the actual performance of this attribute to be assessed. As a result, the similarity between the two terms is highlighted, although the identified dimensions of each attribute do not entirely coincide. The revision allowed three dimensions to be adopted in accordance with the context of the Brazilian public health care system: identification of the basic unit as a regular source of care, a long-lasting treatment bond and continuous information. The proposal of an APS evaluation variables presented herein is line with these dimensions.