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1.
Crit Care Med ; 50(6): 955-963, 2022 06 01.
Article in English | MEDLINE | ID: covidwho-1883053

ABSTRACT

OBJECTIVES: As the pandemic advances, the interest in the long-lasting consequences of COVID-19 increases. However, a few studies have explored patient-centered outcomes in critical care survivors. We aimed to investigate frailty and disability transitions in COVID-19 patients admitted to ICUs. DESIGN: Prospective cohort study. SETTING: University hospital in Sao Paulo. PATIENTS: Survivors of COVID-19 ICU admissions. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We assessed frailty using the Clinical Frailty Scale (CFS). We also evaluated 15 basic, instrumental, and mobility activities. Baseline frailty and disability were defined by clinical conditions 2-4 weeks before COVID-19, and post-COVID-19 was characterized 90 days (day 90) after hospital discharge. We used alluvial flow diagrams to visualize transitions in frailty status, Venn diagrams to describe the overlap between frailty and disabilities in activities of daily living, and linear mixed models to explore the occurrence of new disabilities following critical care in COVID-19. We included 428 participants with a mean age of 64 years, 57% males, and a median Simplified Acute Physiology Score-3 score of 59. Overall, 14% were frail at baseline. We found that 124/394 participants (31%) were frail at day 90, 70% of whom were previously non-frail. The number of disabilities also increased (mean difference, 2.46; 95% CI, 2.06-2.86), mainly in participants who were non-frail before COVID-19. Higher pre-COVID-19 CFS scores were independently associated with new-onset disabilities. At day 90, 135 patients (34%) were either frail or disabled. CONCLUSIONS: Frailty and disability were more frequent 90 days after hospital discharge compared with baseline in COVID-19 patients admitted to the ICU. Our results show that most COVID-19 critical care survivors transition to poorer health status, highlighting the importance of long-term medical follow-up for this population.


Subject(s)
COVID-19 , Fatigue Syndrome, Chronic , Frailty , Activities of Daily Living , Brazil , Critical Care , Critical Illness/epidemiology , Female , Frailty/epidemiology , Humans , Male , Middle Aged , Patient-Centered Care , Prospective Studies , Survivors
3.
Z Evid Fortbild Qual Gesundhwes ; 171: 6-10, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1852262

ABSTRACT

Five years ago, we published a 'wake-up' paper on shared decision-making (SDM) in West Africa. In the current paper, our overview has been expanded to more African regions (central and north, in addition to the west) as well as to person-centred care (PCC) approaches. While these concepts are known in all regions to varying degrees, results indicate that most known SDM and PCC efforts originate from West Africa. In general, the focus seems to be predominantly on partnership-driven healthcare programs, such as COVID-19 infection; HIV/AIDS and maternal/neonatal care; and patient-provider communication and patient participation instead of comprehensive SDM approaches. The findings also indicate the absence of SDM training for African health professionals beyond specific healthcare programs, but some education on decision-making or critical appraisal of health information in primary or undergraduate health schools is carried out in certain African countries. Building on these sectoral initiatives, future directions include developing research and training programs in the perspective of scaling effective approaches.


Subject(s)
COVID-19 , Decision Making , Germany , Humans , Infant, Newborn , Patient Participation , Patient-Centered Care
4.
Acta Biomed ; 93(2): e2022182, 2022 05 11.
Article in English | MEDLINE | ID: covidwho-1848013

ABSTRACT

After the implementation of mass vaccination campaigns, breakthrough infections by SARS-CoV-2 are being increasingly observed worldwide, due to high pervasiveness of viral spread, emergence of novel variants, progressive ease of restrictive measures and waning protection against infection. Although breakthrough infections have generally lower clinical severity than COVID-19 in unvaccinated subjects, a consistent number of patients may still require hospitalization. These patients are generally old, frail and with a high number of comorbidities. Despite COVID-19-related symptoms are generally milder, they may still exhibit complicated clinical course for their intrinsic clinical complexity. The organization of hospital care should thus consider the changing epidemiology of patients admitted with SARS-CoV-2 infection in the post-vaccine era, to improve the quality and appropriateness of care.


Subject(s)
COVID-19 , COVID-19 Vaccines , Hospitalization , Humans , Mass Vaccination , Patient-Centered Care , SARS-CoV-2 , Vaccination
5.
J Health Care Poor Underserved ; 33(2): 1123-1128, 2022.
Article in English | MEDLINE | ID: covidwho-1846909

ABSTRACT

United States community health centers address socioeconomic and environmental conditions and provide comprehensive primary care despite market forces that reinforce a medical model. Collaborating with 14 health center organizations, the RCHN Community Health Foundation promoted the original and broader health center vision of health, launching its population health management initiative in 2015. Although participating organizations were recognized as patient-centered medical homes and achieved rewards for quality, most identified gaps in their capacity for population health management. These challenges, addressed through peer learning and local initiatives, included engaging target populations, care coordination, socioeconomic and clinical data collection, and working with nontraditional local organizations. With relatively small funding, the zeal and enthusiasm for population health was revitalized among health center staff. The current pandemic and growing national concern for health disparities represents an opportunity to expand this broader vision of population health and to sustain it as the COVID-19 pandemic eventually subsides.


Subject(s)
COVID-19 , Population Health , COVID-19/epidemiology , Community Health Centers , Humans , Pandemics , Patient-Centered Care , United States
6.
Aust J Gen Pract ; 51(5): 357-364, 2022 05.
Article in English | MEDLINE | ID: covidwho-1836493

ABSTRACT

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic has significantly affected primary healthcare systems throughout the world. The aim of this article is to present the analysis of the perspectives and experiences of patient-centred care (PCC) during the pandemic by high-functioning general practice teams in Australia. METHOD: A qualitative descriptive approach and collective case study method was employed. Participants, who undertook a semi-structured interview, were representatives of high-functioning general practice teams. Reflective thematic analysis was applied to all interview data (meta-synthesis) using a constant comparison approach. RESULTS: Five clinic representatives were interviewed. Six themes developed, highlighting that despite the pandemic creating new challenges to delivering PCC, general practice teams maintained a focus on PCC. General practice teams adapted to deliver PCC through strategies not used prior to the pandemic. DISCUSSION: This study identified new approaches to PCC that can guide other general practices and progress the health system towards policy-based PCC objectives.


Subject(s)
COVID-19 , General Practice , Humans , Pandemics , Patient-Centered Care , Qualitative Research
8.
Int J Environ Res Public Health ; 19(9)2022 04 21.
Article in English | MEDLINE | ID: covidwho-1818125

ABSTRACT

The COVID-19 pandemic has strained long-term care organization staff and placed new demands on them. This study examines the role of the general ability and power of a long-term care organization to act and react collectively as a social system, which is called systemic agency capacity, in safeguarding the provision of person-centered care during a crisis. The question of how the systemic agency capacity of long-term care organizations helps to ensure person-centered care during the pandemic is an open research question. We conducted a pooled cross-sectional study on long-term care organizations in Germany during the first and second waves of the pandemic (April 2020 and December 2020-January 2021). The sample consisted of 503 (first wave) and 294 leaders (second wave) of long-term care organizations. The top managers of these facilities were asked to report their perceptions of their facility's agency capacity, measured by the AGIL scale, and the extent to which the facility provides person-centered care. We found a significant positive association between the leaders' perceptions of systemic agency capacity and their perceptions of delivered person-centered care, which did not change over time. The results tentatively support the idea that fostering the systemic agency capacity of long-term care organizations facilitates their ability to provide quality routine care despite environmental shocks such as the COVID-19 pandemic.


Subject(s)
COVID-19 , COVID-19/epidemiology , Cross-Sectional Studies , Humans , Long-Term Care , Pandemics , Patient-Centered Care , SARS-CoV-2
9.
Int Psychogeriatr ; 34(3): 227-228, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1805528
10.
Int J Environ Res Public Health ; 19(7)2022 04 04.
Article in English | MEDLINE | ID: covidwho-1785657

ABSTRACT

The last decade has seen numerous policy reforms to emplace person-centered social care. Consequently, the public has been given more information, choice, and autonomy to decide how best they want to be cared for later in life. Despite this, adults generally fail to plan or prepare effectively for their future care needs. Understanding the behavioral antecedents of person-centered decision-making is thus critical for addressing key gaps in the provision of quality social care. To this end, we conducted a literature review of the psychological and health sciences with the aim of identifying the aspects that influence person-centered decision-making in social care. Using an established theoretical framework, we distilled nine behavioral factors-knowledge, competency, health, goal clarity, time discounting, familiarity, cognitive biases, cognitive overload, and emotion-associated with "Capability," "Opportunity," "Motivation," and "Behavior" that explained person-centered decision-making in social care. These factors exist to different degrees and change as a person ages, gradually impacting their ability to obtain the care they want. We discuss the role of carers and the promise of shared decision-making and conclude by advocating a shift from personal autonomy to one that is shared with carers in the delivery of quality social care.


Subject(s)
Caregivers , Social Support , Adult , Caregivers/psychology , Decision Making , Decision Making, Shared , Humans , Patient-Centered Care , Personal Autonomy , Quality of Health Care
11.
Clin Pediatr (Phila) ; 61(5-6): 418-427, 2022 06.
Article in English | MEDLINE | ID: covidwho-1775091

ABSTRACT

Addressing breastfeeding issues enables mothers to reach their breastfeeding goals. We embedded a breastfeeding consultation service run by a pediatrician/International Board Certified Lactation Consultant (MD/IBCLC) in a medical home. This mixed-methods study investigated breastfeeding preparedness and the service's perceived benefits. Mothers with breastfeeding issues/concerns identified at well-baby appointments were referred to the service. Telephone interviews and chart reviews were conducted with 28 participating mothers approximately 1 month after the visits. Breastfeeding Self-Efficacy Scale scores improved significantly from the time of the in-person appointment to 1 month later. Most mothers felt unprepared for breastfeeding despite prenatal efforts. Trust in the pediatrician's recommendation, easy access, and insurance coverage were key factors in seeking the service. Reassurance provided by the MD/IBCLC increased mothers' confidence to breastfeed. The COVID-19 pandemic heightened feelings of isolation and anxiety due to lack of hands-on support from friends and family during the birth hospitalization and when at home.


Subject(s)
Breast Feeding , COVID-19 , Child , Female , Humans , Infant , Mothers , Pandemics , Patient-Centered Care , Pregnancy
12.
J Prim Care Community Health ; 13: 21501319221088823, 2022.
Article in English | MEDLINE | ID: covidwho-1759669

ABSTRACT

INTRODUCTION: The once-in-a-generation COVID-19 pandemic accelerated the pace at which virtual care (VC) was advanced to triage, evaluate, and care for patients. An early adopter of VC delivery, Mayo Clinic had provided video visits and other remote care options for more than 5 years, yet the need for VC during the pandemic surpassed our available capacity for telehealth care. METHODS: To continue providing high-quality care while preventing exposure of patients and staff to high-risk environments, staff from Primary Care and Express Care (minor acute services) collaborated to expand the outpatient VC service to triage patients with acute or chronic symptoms and to address concerns that could be managed remotely. We aimed to maximize the treatment options available outside of high-cost settings and also aimed to accelerate development of longer-term solutions for improving care coordination and continuous population management. RESULTS: Patient use of virtual visits showed an unprecedented increase after changes were implemented that expanded the existing virtual visit menu, facilitated patient self-triage and direct scheduling, streamlined physical connections for virtual appointments, and incorporated additional language (medical interpreter) support. The combination of patient convenience, ease of scheduling, and added safety for providers and patients, in conjunction with other telehealth options, resulted in a better overall patient experience. CONCLUSION: Any organization that is considering deploying a sustainable program of VC must put patient needs and safety at the center. Organizations should seize opportunities to agilely adjust and advance any emergency-response solutions to serve a longer-term purpose.


Subject(s)
COVID-19 , Telemedicine , Continuity of Patient Care , Humans , Pandemics/prevention & control , Patient-Centered Care
13.
Reprod Sci ; 29(4): 1188-1196, 2022 04.
Article in English | MEDLINE | ID: covidwho-1756997

ABSTRACT

Uterine fibroids are common benign tumors that occur in up to 80% of women. Approximately half of the women affected experience considerable physical, psychological, and economic burdens and impact on quality of life due to symptoms such as heavy menstrual bleeding, pelvic pain, and infertility. Several medical and surgical options are available to treat uterine fibroids; however, healthcare providers may benefit from practical guidance in the development of individualized treatment plans based on a personalized approach. Medical treatments and minimally invasive procedures are generally preferred by most patients before considering more invasive, higher risk surgical interventions. In general, patient-centered, uterine-preserving procedures may be prioritized based on the patient's goals and the clinical scenario. Occasionally, hysterectomy may be the preferred treatment option for some patients who require definitive treatment. This call-to-action highlights recent challenges to patient care, including radical shifts in physician-patient interactions due to the COVID-19 pandemic and recent changes to evidence-based, clinically approved therapies. This report also reviews contemporary recommendations for women's health providers in the diagnosis and medical and surgical management of uterine fibroids. This call-to-action aims to empower healthcare providers to optimize the quality of care for women with uterine fibroids utilizing the best available evidence and best practices.


Subject(s)
Disease Management , Evidence-Based Practice , Leiomyoma/therapy , Uterine Neoplasms/therapy , Female , Humans , Patient-Centered Care , Practice Guidelines as Topic , Quality of Health Care , Quality of Life
14.
Am J Manag Care ; 28(3): e80-e87, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1754305

ABSTRACT

OBJECTIVES: The COVID-19 pandemic has caused hospitals around the world to quickly develop not only strategies to treat patients but also methods to protect health care and frontline workers. STUDY DESIGN: Descriptive study. METHODS: We outlined the steps and processes that we took to respond to the challenges presented by the COVID-19 pandemic while continuing to provide our routine acute care services to our community. RESULTS: These steps and processes included establishing teams focused on maintaining an adequate supply of personal protection equipment, cross-training staff, developing disaster-based triage for the emergency department, creating quality improvement teams geared toward updating care based on the most current literature, developing COVID-19-based units, creating COVID-19-specific teams of providers, maximizing use of our electronic health record system to allocate beds, and providing adequate practitioner coverage by creating a computer-based dashboard that indicated the need for health care practitioners. These processes led to seamless and integrated care for all patients with COVID-19 across our health system and resulted in a reduction in mortality from a high of 20% during the first peak (March and April 2020) to 6% during the plateau period (June-October 2020) to 12% during the second peak (November and December 2020). CONCLUSIONS: The detailed processes put in place will help hospital systems meet the continuing challenges not only of COVID-19 but also beyond COVID-19 when other unique public health crises may present themselves.


Subject(s)
COVID-19 , Delivery of Health Care , Humans , Pandemics , Patient-Centered Care , SARS-CoV-2
15.
PLoS One ; 17(3): e0265091, 2022.
Article in English | MEDLINE | ID: covidwho-1753194

ABSTRACT

The COVID-19 pandemic has abruptly changed care priority and delivery, delaying others like the multimorbidity approach. The Centro de Innovación en Salud ANCORA UC, the Health National Fund, and the Servicio de Salud Metropolitano Sur Oriente implemented a Multimorbidity Patient-Centered Care Model as a pilot study in the public health network from 2017 to 2020. Its objective was to reorganize the single diagnosis standard care into a new one based on multimorbidity integrated care. It included incorporating new roles, services, and activities according to each patient's risk stratification. This study aims to describe the perception of the health care teams regarding the impact of the COVID-19 pandemic on four main topics: how the COVID-19 pandemic affected the MCPM implementation, how participants adapted it, lessons learned, and recommendations for sustainability. We conducted a qualitative study with 35 semi-structured interviews between October and December 2020. Data analysis was codified, triangulated, and consolidated using MAXQDA 2020. Results showed that the pandemic paused the total of the implementation practically. Positive effects were the improvement of remote health care services, the activation of self-management, and the cohesion of the teamwork. In contrast, frequent abrupt changes and reorganization forced by pandemic evolution were negative effects. This study revealed the magnitude of the pandemic in the cancelation of health services and identified the urgent need to restart chronic services incorporating patient-centered care in our system.


Subject(s)
COVID-19/epidemiology , Patient-Centered Care/methods , Female , Health Personnel , Humans , Male , Multimorbidity , Pilot Projects , Qualitative Research , Self Care
16.
BMJ Qual Saf ; 31(3): 172-174, 2022 03.
Article in English | MEDLINE | ID: covidwho-1745681
17.
J Gerontol Nurs ; 48(3): 11-16, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1726165

ABSTRACT

Various factors impact end-of-life (EOL) for older adults. This period is more complex for older adults with severe and persistent mental illness (SPMI). The current article aims to explore a non-exhaustive list of person-level and environmental factors that may impact EOL for older adults with SPMI. [Journal of Gerontological Nursing, 48(3), 11-16.].


Subject(s)
Hospice Care , Mental Disorders , Terminal Care , Aged , Chronic Disease , Humans , Mental Disorders/therapy , Patient-Centered Care
18.
Healthc Q ; 24(4): 61-68, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1716158

ABSTRACT

The healthcare system has undergone a transformational shift toward people-centred care (PCC), and healthcare leaders are accountable for enabling this culture change. This paper describes the University Health Network's journey of using a person-centred approach for cultural transformation, reflecting on (a) the leadership elements required to build and sustain a culture of PCC; (b) the importance of establishing a Patient Declaration of Values, which is a framework for patient care; and (c) how this culture led our approach during the COVID-19 pandemic.


Subject(s)
COVID-19 , Leadership , COVID-19/epidemiology , Humans , Pandemics , Patient-Centered Care , SARS-CoV-2
19.
Pediatrics ; 149(3)2022 03 01.
Article in English | MEDLINE | ID: covidwho-1714832

ABSTRACT

The use of telehealth technology to connect with patients has expanded significantly over the past several years, particularly in response to the global coronavirus disease 2019 pandemic. This technical report describes the present state of telehealth and its current and potential applications. Telehealth has the potential to transform the way care is delivered to pediatric patients, expanding access to pediatric care across geographic distances, leveraging the pediatric workforce for care delivery, and improving disparities in access to care. However, implementation will require significant efforts to address the digital divide to ensure that telehealth does not inadvertently exacerbate inequities in care. The medical home model will continue to evolve to use telehealth to provide high-quality care for children, particularly for children and youth with special health care needs, in accordance with current and evolving quality standards. Research and metric development are critical for the development of evidence-based best practices and policies in these new models of care. Finally, as pediatric care transitions from traditional fee-for-service payment to alternative payment methods, telehealth offers unique opportunities to establish value-based population health models that are financed in a sustainable manner.


Subject(s)
Health Care Costs , Health Services Accessibility/organization & administration , Pediatrics/methods , Pediatrics/organization & administration , Quality of Health Care/organization & administration , Telemedicine/methods , Telemedicine/organization & administration , Adolescent , Child , Child, Preschool , Healthcare Disparities , Humans , Infant , Infant, Newborn , Patient-Centered Care/economics , Patient-Centered Care/organization & administration , Pediatrics/economics , Pediatrics/standards , Telemedicine/economics , Telemedicine/standards , United States
20.
Nat Med ; 28(4): 809-813, 2022 04.
Article in English | MEDLINE | ID: covidwho-1713203

ABSTRACT

Large traditional clinical trials suggest that sodium-glucose co-transporter 2 inhibitors improve symptoms in patients with heart failure and reduced ejection fraction (HFrEF) and in patients with heart failure and preserved ejection fraction (HFpEF). In the midst of the Coronavirus Disease 2019 pandemic, we sought to confirm these benefits in a new type of trial that was patient centered and conducted in a completely remote fashion. In the CHIEF-HF trial ( NCT04252287 ), 476 participants with HF, regardless of EF or diabetes status, were randomized to 100 mg of canagliflozin or placebo. Enrollment was stopped early due to shifting sponsor priorities, without unblinding. The primary outcome was change in the Kansas City Cardiomyopathy Questionnaire Total Symptom Score (KCCQ TSS) at 12 weeks. The 12-week change in KCCQ TSS was 4.3 points (95% confidence interval, 0.8-7.8; P = 0.016) higher with canagliflozin than with placebo, meeting the primary endpoint. Similar effects were observed in participants with HFpEF and in those with HFrEF and in participants with and without diabetes, demonstrating that canagliflozin significantly improves symptom burden in HF, regardless of EF or diabetes status. This randomized, double-blind trial, conducted without in-person interactions between doctor and patient, can serve as a model for future all-virtual clinical trials.


Subject(s)
COVID-19 , Heart Failure , Sodium-Glucose Transporter 2 Inhibitors , Ventricular Dysfunction, Left , Canagliflozin/pharmacology , Canagliflozin/therapeutic use , Heart Failure/diagnosis , Heart Failure/drug therapy , Humans , Patient-Centered Care , Quality of Life , Sodium-Glucose Transporter 2 Inhibitors/therapeutic use , Stroke Volume
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