Partnership-based nursing practice framework for patients with advanced chronic obstructive pulmonary disease and their families-A discursive paper.

AIM: The increase in the number of people with chronic obstructive pulmonary disease (COPD) and the disease burden, has prompted concerted efforts to improve healthcare, particularly outpatient services. In line with these attempts the Partnership-Based Nursing Practice Theoretical Framework for People with COPD was developed to guide outpatient nursing care. The principal approach of the framework is a 'Dialogue' with the patients, which has four components: 'Establishing family involvement', 'Assisting living with symptoms' and 'Facilitating access to healthcare', with the primary goal being 'Enhancement of the health experience'. With new knowledge, research on the framework, and extensive experience in using it, a need arose to modify the framework to maximize its clinical utility. DESIGN: Discursive paper. METHODS: A narrative review and critical reflection was conducted to revise the nursing practice framework via selected literature search from 2012 to 2022, research on the framework, and the authors' reflections on the clinical experience of using the framework. RESULTS: The nursing practice framework highlights capacities and possibilities that lie in the nurse-patient relationship. The overarching dialogue in the revised framework includes both patients and families. The action-related component 'Assisting living with the disease' was added to the framework to underscore the significance of attempting to understand what may lie ahead for patients and families. The other action-related components are as follows: 'Assisting living with symptoms' and 'Facilitating access to healthcare'. The primary goal remains unchanged: enhancing the 'Health experience'. CONCLUSION: Using the revised nursing practice framework in outpatient care may help to enhance the lives of people with COPD and their families, particularly at advanced stages of the disease. It may have transferability to other groups of people living with progressive diseases dealing with complicated health problems, and to reduce the usage of costly healthcare resources such as hospital care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The partnership-based nursing practice framework assumes an extension of conventional specialized respiratory service and embraces a comprehensive account for that which may influence the patient's health problems. This guidance, which holistically attends to patient-family needs of living with complicated and progressive health predicaments, is fundamental. It contributes to strengthening the disciplinary focus of nursing, interdisciplinary collaboration, person-family-centred quality nursing care and inspires research initiatives. Critical reflections and updates on nursing practice frameworks, such as this revision, are essential to advance nursing and healthcare. PATIENT OR PUBLIC CONTRIBUTION: There is no direct patient- or public contribution.

External urology consultation quality at a third-level public hospital in Mexico.

INTRODUCTION: Patient satisfaction is the degree of conformity with the healthcare they receive. It is real evidence and one of the most important factors in determining the effectiveness and quality of healthcare systems. OBJECTIVE: To identify the quality of care in the Urology outpatient department of a third-level hospital. MATERIALS AND METHODS: The NHS (National Health Service) 2018 quality of care questionnaire with 11 sections, 133 items, and duration of approximately 25min was randomly administered to 250 patients attending Urology outpatients at a third-level public hospital in Mexico. RESULTS: According to responses, 92% (n=230) knew the reason for the consultation. 64.8% (n=162) had a consultation with the same physician by whom they were initially seen. The longest reported hospital wait time before being seen was more than 2h in 29.6% (n=74). As for consultation time, 212 patients responded and the duration was 11-20min in 52.8% (n=112). Finally, 33.2% (n=83) considered the quality of service to be good. CONCLUSIONS: The use of the NHS 2018 survey in the Urology service at a third-level public hospital in Mexico is feasible, since we managed to obtain a significant and continuous improvement in all its indicators which is satisfactory for all.

Pediatric outpatient experiences of senior nursing students: A qualitative study.

OBJECTIVES: This study aimed to explore the experiences of senior nursing students working in a pediatric outpatient clinic. METHODS: This study adopted a descriptive phenomenological approach, through semi-structured interviews. Purposive sampling was used to select 12 senior nursing students in the pediatric outpatient clinic of West China Second University Hospital, Sichuan University, China, from August 2020 to March 2021. The collected data were analyzed using the Colaizzi method. RESULTS: Four themes were identified in this study: knowledge and skills (triage, emergency care), communication (courage, communication skills), value re-evaluation (understand of outpatient nurses, judgment of outpatient nurses), and outpatient feelings (satisfaction, empathy, pressure). CONCLUSION: Pediatric outpatient internships have a positive impact on senior nursing students. Research has found that constructing a nursing clinical practice pathway in pediatric outpatient clinics helps teachers and students clarify the objectives and content of internships, and the "shadow teaching" model is conducive to nursing students' empathy and thinking. In addition, outpatient internship experience can help students gain communication courage.

The COVID-19 pandemic and healthcare utilization in Iran: evidence from an interrupted time series analysis.

BACKGROUND: This study aimed to examine the effect of the coronavirus disease 2019 (COVID-19) outbreak on the hospitalization rate, emergency department (ED) visits, and outpatient clinic visits in western Iran. METHODS: We collected data on the monthly hospitalization rate, rate of patients referred to the ED, and rate of patients referred to outpatient clinics for a period of 40 months (23 months before and 17 months after the COVID-19 outbreak in Iran) from all 7 public hospitals in the city of Kermanshah. An interrupted time series analysis was conducted to examine the impact of COVID-19 on the outcome variables in this study. RESULTS: A statistically significant decrease of 38.11 hospitalizations per 10,000 population (95% confidence interval [CI], 24.93-51.29) was observed in the first month of the COVID-19 outbreak. The corresponding reductions in ED visits and outpatient visits per 10,000 population were 191.65 (95% CI, 166.63-216.66) and 168.57 (95% CI, 126.41-210.73), respectively. After the initial reduction, significant monthly increases in the hospitalization rate (an increase of 1.81 per 10,000 population), ED visits (an increase of 2.16 per 10,000 population), and outpatient clinic visits (an increase of 5.77 per 10,000 population) were observed during the COVID-19 pandemic. CONCLUSION: Our study showed that the utilization of outpatient and inpatient services in hospitals and clinics significantly declined after the COVID-19 outbreak, and use of these services did not return to pre-outbreak levels as of June 2021.

Patients experience regarding home mechanical ventilation in an outpatient setting.

BACKGROUND: The patient's experience of treatment is a cornerstone of high-quality healthcare, along with clinical safety and effectiveness. We aimed to evaluate the patients' perspectives regarding home mechanical ventilation (HMV) follow up in an outpatient setting and ascertain differences between patients that started HMV in the outpatient setting compared to other settings. METHODS: This cross-sectional study was conducted with patients with chronic respiratory failure under HMV in the Outpatient Ventilation Clinic. Patients filled in a patient experience questionnaire and the S3-NIV questionnaire. RESULTS: The study included 235 patients (127, 54% male), median 70 [25-75 percentiles 64-76] years) and about half were adapted to HMV in the outpatient setting (117, 49.8%). Patients had a daily ventilator usage of 8.0 [6.0-10.0] hours and have been on ventilator for a median of 35.0 [12.0-66.0] months. Patients reported an overall good experience regarding education at initiation (209 [88.9%] considered the information given was enough), short time to adaptation [104 (44.3%) felt adapted after some hours], with perceived benefits (171 [72.8%] reported less shortness of breath, 158 (67.2%) improved quality of life and 150 (63.8%) less tiredness). Benefits overcame the treatment side-effects (158 [67.2%] reported mucosal dryness, 109 (46.4%) mask sores and 96 (40.9%) leaks). There was no difference in terms of reported health gains, side effects or time to adaptation between adaptation settings, but patients starting HMV in the outpatient setting reported better communication and education at adaptation. CONCLUSIONS: Outpatient setting was perceived as a positive experience, both in HMV initiation and follow up, with good patient-physician communication leading to significant health reported gains, improvement of health status and well-being and good treatment adherence.

Costs associated with United States pharmacopeia compliant infusion clinics.

PURPOSE: As costs continue to rise in oncology, a strategy that has been implemented to limit these costs is use of alternative sites of care. However, there are differences in regulatory standards between common sites of care such as freestanding infusion clinics and hospital outpatient departments. The costs associated with United States Pharmacopeia compliance were evaluated in order to better understand the cost of universally compliant hospital outpatient departments. METHODS: Annual operational costs associated with United States Pharmacopeia compliance were estimated for a 30-chair infusion clinic with United States Pharmacopeia <797> and <800> pharmacy cleanrooms for non-hazardous and hazardous drugs, respectively. Annual United States Pharmacopeia compliance costs included: competency assessments, personal protective equipment, closed system transfer devices, labels, cleaning supplies, and environmental monitoring. One-time costs included initial cleanroom construction and renovations. Published information and benchmarks provided baseline assumptions for patient volume, staffing, and unit costs. If no published data was available, prices were estimated based on a similarly sized clinic. RESULTS: Recurring annual costs for a 30-chair fully compliant infusion clinic were calculated to be $785,207. One-time costs associated with initial construction and renovations were estimated to be $1,365,207-$1,535,207 and $965,207-$1,005,207, respectively. CONCLUSIONS: Costs associated with increased operational oversight and regulatory standards are a major contributing factor to the facility fee of hospital outpatient departments. Ultimately, all sites of care share in the goal to provide optimal patient care while considering all aspects of patient care, including cost. Therefore, a move towards consistent regulatory standards across all settings would aid in preventing discrepancies in care.

Psychosocial risks related to the organization of outpatient nursing work / Riesgos psicosociales relacionados con la organización del trabajo de enfermería ambulatoria / Riscos psicossociais relacionados à organização do trabalho da enfermagem ambulatorial

ABSTRACT Objective: to analyze the psychosocial risks related to the organization of nursing work in outpatient clinics of university hospitals. Method: cross-sectional epidemiological study developed in 11 outpatient units linked to the three public universities of the city of Rio de Janeiro, Brazil. Participants were 388 nursing professionals who worked in patient care at the time of the research. Data were collected from July to December 2018, using a self-applicable instrument. A questionnaire was used for sociodemographic, occupational and health characterization, and the Work Organization Scale. The bivariate analyses were performed using the odds ratio (OR), with a confidence interval of 95%, significance level of 5%. Results: the organization of nursing work received an assessment of medium psychosocial risk by the professionals participating in the research, demanding interventions in the short and medium term. There was no association between sociodemographic, occupational and health characteristics and the organization of outpatient work. Conclusion: interventional measures should be performed in the psychosocial risk factors presented in this research, with a view to improving the work environment, so that the importance of maintaining satisfactory material conditions is considered, as well as the adequate quantity of human resources. In addition, it aims to expand the spaces of nursing participation in decision-making, strengthening its autonomy as a profession.

RESUMEN Objetivo: analizar los riesgos psicosociales relacionados con la organización del trabajo de enfermería en las consultas externas de los hospitales universitarios. Método: estudio epidemiológico transversal desarrollado en 11 unidades ambulatorias vinculadas a las tres universidades públicas de la ciudad de Río de Janeiro, Brasil. Los participantes fueron 388 profesionales de enfermería que trabajaban en la atención al paciente en el momento de la investigación. Los datos se recolectaron de julio a diciembre de 2018, utilizando un instrumento autoaplicable. Se utilizó un cuestionario para la caracterización sociodemográfica, ocupacional y de salud, y la Escala de Organización del Trabajo. Los análisis bivariados se realizaron utilizando el odds ratio (OR), con un intervalo de confianza del 95%, nivel de significancia del 5%. Resultados: la organización del trabajo de enfermería recibió una evaluación del riesgo medio psicosocial por parte de los profesionales participantes en la investigación, exigiendo intervenciones en el corto y mediano plazo. No hubo asociación entre las características sociodemográficas, ocupacionales y de salud y la organización del trabajo ambulatório. Conclusión: se deben realizar medidas de intervención en los factores de riesgo psicosocial presentados en esta investigación, con miras a mejorar el clima laboral, a fin de considerar la importancia de mantener condiciones materiales satisfactorias, así como la cantidad adecuada de recursos humanos. Además, se busca ampliar los espacios de participación de la enfermería en la toma de decisiones, fortaleciendo su autonomía como profesión.

RESUMO Objetivo: analisar os riscos psicossociais relacionados à organização do trabalho de enfermagem em ambulatórios de hospitais universitários. Método: estudo epidemiológico transversal desenvolvido em 11 unidades ambulatoriais vinculadas às três universidades públicas do município do Rio de Janeiro, Brasil. Participaram 388 trabalhadores de enfermagem, que atuavam na assistência à época da pesquisa. A coleta de dados foi realizada no período de julho a dezembro de 2018, por meio de um instrumento autoaplicável. Utilizou-se um questionário para caracterização sociodemográfica, ocupacional e de saúde, e a Escala de Organização do Trabalho. As análises bivariadas foram realizadas utilizando a razão de chances, odds ratio (OR), com intervalo de confiança de 95%, nível de significância de 5%. Resultados: a organização do trabalho de enfermagem recebeu avaliação de risco psicossocial médio pelos profissionais participantes da pesquisa, demandando intervenções a curto e médio prazo. Não houve associação entre as características sociodemográficas, ocupacionais e de saúde e a organização do trabalho ambulatorial. Conclusão: medidas interventivas devem ser realizadas nos fatores de risco psicossocial apresentados nesta pesquisa, na perspectiva de melhorar o ambiente de trabalho, de forma que se considere a importância da manutenção de condições materiais satisfatórias, bem como o quantitativo adequado de recursos humanos. Além disso, visa-se ampliar os espaços de participação da enfermagem na tomada de decisão, fortalecendo sua autonomia enquanto profissão.

Why people select the outpatient clinic of medical centers: a nationwide analysis in Taiwan.

INTRODUCTION: In contrast to other countries, Taiwan's National Health Insurance (NHI) program allows patients to freely select the specialists and tiers of medical care facility without a referral. Some medical centers in Taiwan receive over 10,000 outpatients per day. In the NHI program, the co-payment was increased for high-tier facilities for outpatient visits in 2002, 2005, and 2017. However, the policies only mildly reduced the use of high-tier medical care facilities. The main purpose of this study was to evaluate the factors contributing to the patients' selection of the outpatient clinic of medical centers without a referral. METHODS: An online anonymous survey was conducted by using the Google Forms platform utilizing a self-constructed questionnaire from September to October 2018. A nationwide sample in Taiwan was recruited using convenience sampling through social media. Based on a literature review and a focus group, 20 factors that may affect the choice of the outpatient institution were constructed. The associations between items that affect the patients selection of outpatient clinics were assessed using exploratory factor analysis. Principal axis factoring was performed to identify the major factors affecting the decision. Multiple logistic regression was performed to determine which factors satisfactorily explained "visiting the outpatient clinic of the medical center for an illness without a referral." RESULTS: During the survey period, 5,060 people browsed the online survey, and 1,003 responded and completed the online questionnaire. Therefore, the response rate was 19.8%. A total of 987 valid responses was collected. Exploratory factor analysis revealed that three main factors, namely the "physician factor", "image and reputation factor", and "facility and medication factor", affected the selection of outpatient clinics. A series of logistic regressions indicated that patients who reported that hospital facilities, high-quality drugs, and diverse specialties were very important were more likely to select the outpatient clinic of a medical center (OR = 2.218, 95% CI [1.514-3.249]). Patients who reported that physician factors were very important were less likely to select a medical center (OR = 0.717, 95% CI [0.523-0.984]). Patients who were previously satisfied with their experience of the primary clinics or had a regular family doctor were less likely to choose a medical center (OR = 0.509, 95% CI -0.435-0.595] and OR = 0.676, 95% CI [0.471-0.969]). CONCLUSION: In Taiwan, patients with good primary medical experience and regular family physicians had significantly lower rates by selecting the outpatient clinic of a medical center. The results of this study support that the key to establishing graded medical care is to prioritize the strengthening of the primary medical system.

Rate and predictors for non-attendance of patients undergoing hospital outpatient treatment for chronic diseases: a register-based cohort study.

BACKGROUND: Failure to keep medical appointments results in inefficiencies and, potentially, in poor outcomes for patients. The aim of this study is to describe non-attendance rate and to investigate predictors of non-attendance among patients receiving hospital outpatient treatment for chronic diseases. METHODS: We conducted a historic, register-based cohort study using data from a regional hospital and included patients aged 18 years or over who were registered in ongoing outpatient treatment courses for seven selected chronic diseases on July 1, 2013. A total of 5895 patients were included and information about their appointments was extracted from the period between July 1, 2013 and June 30, 2015. The outcome measure was occurrence of non-attendance. The associations between non-attendance and covariates (age, gender, marital status, education level, occupational status, specific chronic disease and number of outpatient treatment courses) were investigated using multivariate logistic regression models, including mixed effect. RESULTS: During the two-year period, 35% of all patients (2057 of 5895 patients) had one or more occurrences of non-attendance and 5% of all appointments (4393 of 82,989 appointments) resulted in non-attendance. Significant predictors for non-attendance were younger age (OR 4.17 for 18 ≤ 29 years as opposed to 80+ years), male gender (OR 1.35), unmarried status (OR 1.39), low educational level (OR 1.18) and receipt of long-term welfare payments (OR 1.48). Neither specific diseases nor number of treatment courses were associated with a higher non-attendance rate. CONCLUSIONS: Patients undergoing hospital outpatient treatments for chronic diseases had a non-attendance rate of 5%. We found several predictors for non-attendance but undergoing treatment for several chronic diseases simultaneously was not a predictor. To reduce non-attendance, initiatives could target the groups at risk. TRIAL REGISTRATION: This study was approved by the Danish Data Protection Agency (Project ID 18/35695 ).

Modelo ambulatorial de atendimento de nódulo de tireoide / Ambulatory care model thyroid nodule

A prevalência de detecção de nódulos na tireoide através da palpação é de aproximadamente 5%. Essa prevalência sobe para 19 a 67% quando utilizada a avaliação ecográfica. A importância da avaliação clínica dessa entidade está na necessidade de diagnosticar o câncer de tireoide que ocorre em 5 a 10% dos casos. O relato descreve o perfil dos atendimentos realizados no ambulatório de nódulos de tireoide do Hospital Municipal Dr. Mário Gatti no período de 01/05/17 a 27/07/18 de pacientes que tiveram diagnóstico ultrassonográfico de nódulo de tireoide e realizaram punção aspirativa por agulha fina, a fim de inferir a respeito da capacidade de resolutividade do ambulatório interdisciplinar (endocrinologia e cirurgia de cabeça e pescoço) no diagnóstico e tratamento do câncer de tireoide. A organização do ambulatório com atendimento integral e por equipe multidisciplinar, possibilita uma melhora na qualidade assistencial além de ser elemento facilitador para o ensino, aprendizado e pesquisa. (AU)

The rate of thyroid node detection by touch is approximately 5%. This rate goes up to a range between 19 and 67% when a sonographic evaluation is used. The importance of the clinical evaluation of those thyroid nodes is within the need of diagnosing the cancer that occurs in 5 to 10% of the cases. This paper describes the profile of consultations performed at the Outpatient Clinic Thyroid Node Unit of the Municipal Hospital Dr. Mário Gatti (HMMG) from 01/05/17 to 07/27/18, of patients who had ultrasonographic diagnostics of thyroid node and underwent fine-needle aspiration, in order to draw conclusions about the capacity of the interdisciplinary clinic (Endocrinology and Head and Neck surgery) to diagnose and treat thyroid cancer effectively. The organization of the outpatient clinic, with comprehensive care and multidisciplinary team, enables an improvement in medical assistance as well as facilitating teaching, learning and research. (AU)

Outcome of hospital outpatient treatment of functional gastrointestinal disorders.

BACKGROUND: Functional gastrointestinal disorders (FGID) are the commonest conditions observed in gastrointestinal (GI) practice, yet the outcomes of their outpatient care are not known. AIM: To evaluate the outcome for patients with FGID attending a specialist GI clinic. METHODS: Consecutive, newly referred patients with a FGID attending a specialist GI clinic in a tertiary hospital, over a 1-year period were reviewed and then completed a phone survey to assess current symptoms. RESULTS: Of 102 patients, 57% had irritable bowel syndrome, 28% functional dyspepsia and 15% other functional disorders. At interview, a median of 402 days after the last consultation 38% expressed symptom improvement, but 64% remained concerned about their condition despite 62% having been reassured. After treatment, 50% of employed patients took time off work because of gut symptoms. Functional dyspepsia patients were less likely to be symptomatically improved than other FGID (21% vs 45%, P = 0.02). Patients given a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols were more likely than others to achieve symptom improvement (53% vs 31%, P = 0.03); PPI-treated patients were less likely to experience improvement (22% vs 44%, P = 0.05); other treatments did not predict outcome. Number of visits, seniority of clinician, duration of care and comorbidities did not predict outcome. CONCLUSION: One year after attending a specialist GI clinic a minority of patients with FGID were symptomatically improved. Failure to benefit by many patients may relate to the nature of patients and conditions being treated or the limited nature and range of treatments offered. Different models of care, including more diverse multidisciplinary models, should be explored.

Sala de espera do ambulatório de transplante de medula óssea: experiências de pacientes e acompanhantes / Salle d'attente de l'ambulatoire de greffe de moelle osseuse: expériences de patients et leurs accompagnateurs / Sala de espera del ambulatorio de trasplante de médula ósea: experiencias de los pacientes y sus cuidadores / Waiting room of the bone marrow transplant outpatient clinic: patient and companion experiences

Resumo O transplante de células-tronco hematopoiéticas é um procedimento de alta complexidade que vem se constituindo como uma alternativa para algumas doenças potencialmente graves e desencadeadoras de uma série de afecções. A proposta deste estudo é examinar aquilo que o paciente experimenta durante o processo do transplante, especificamente, enquanto aguarda atendimento na sala de espera. Utilizando a narrativa como método de pesquisa, trabalha com o conceito de inconsciente, cuja referência é a teoria psicanalítica. Os resultados encontrados remetem a dois pontos axiais: a imisção do sujeito, isto é, como a questão da identidade passa pela alteridade; e a expectativa por respostas em uma clínica em que as alterações orgânicas podem ser muito ameaçadoras em sua evolução. O percurso feito dá ensejo à pergunta sobre o lugar da palavra na instituição hospitalar e conclui com a proposta que ampliemos nosso olhar sobre aqueles de quem cuidamos.

Resumé La transplantation de cellules-souches hématopoïétiques est une procédure très complexe, qui réprésente une alternative pour certaines maladies pottentiellement graves et capables de déclancher une séries d'affections. Le but de cette étude est de s'attarder sur ce que le patient éprouve lorsqu'il se trouve dans la salle d'attente pour se faire soigner. Prenant le récit comme méthode de recherche, l'étude s'utilise du concept d'insconscient, emprunté à la théorie psychanalytique. Les résultats nous remettent à deux points axiaux: l'immixtion du sujet, c'est-à-dire, la manière dont la question de l'identité passe par l'altérité et l'espoir d'entendre des réponses au sein d'une clinique où les altérations de l'organisme peuvent se révéler très menaçantes au cours de leur évolution. Le chemin parcouru soulève la question de la place occupée par la parole dans l'institution hospitalière et conclut par la recommandation d'amplifier notre regard sur tous ceux à qui nous apportons des soins.

Resumen El trasplante de células madre hematopoyéticas es un procedimiento de alta complejidad, que se constituye como alternativa para algunas enfermedades potencialmente graves y desencadenantes de una serie de afecciones. La propuesta de este estudio es examinar lo que el paciente experimenta durante el proceso de trasplante, específicamente mientras aguarda en la sala de espera. Utilizando la narrativa como método de investigación, se trabaja con el concepto de inconsciente, cuya referencia teórica es la teoría psicoanalítica. Los resultados encontrados remiten a dos puntos centrales: la intromisión del sujeto, es decir, como la cuestión de la identificación pasa por la alteridad; y la expectativa por la respuesta en una clínica en que las alteraciones orgánicas pueden ser muy impactantes en su evolución. El recorrido realizado da lugar a la pregunta sobre el lugar de la palabra en el hospital, y concluye con una propuesta para que ampliemos nuestra mirada sobre aquellos que cuidamos.

Abstract Hematopoietic stem cell transplantation is a highly complex procedure that is becoming an alternative to some potentially serious diseases that trigger a series of conditions. The purpose of this study is to examine what the patient experiences during the transplant process, specifically while awaiting care in the waiting room. Using the narrative as a method of research, we work with the concept of unconscious, whose reference is the psychoanalytic theory. Results found refer to two axial points: the subject's immixing, i.e., how the issue of identity passes through the otherness; and the expectation of answers in a clinic where organic changes can be very threatening in their evolution. The path traversed gives rise to questions on the role of the word in hospital institutions and concludes with the proposal that we expand our view on those of whom we care.

Head and neck cancer: validation of a data collection instrument / Cáncer de cabeza y cuello: validación de instrumento para la recolección de datos / Câncer de cabeça e pescoço: validação de instrumento para coleta de dados

ABSTRACT Objective: construct and validate the content of an instrument to collect data from patients with head and neck cancer (HNC) served in a specialty clinic. Method: methodological study consisting of four steps. The first step consisted in the preparation of the instrument using databases and the theoretical model of Marjory Gordon. In the second and third steps the content was validated by eight nursing judges. The evaluation used the Content Validity Index (CVI). The fourth step consisted in a pilot test with seventeen HNC patients. Results: of the 88 questions formulated and organized on the dimensions of structure and process submitted to validation, items with CVI lower than 0.80 were excluded. The final instrument was composed of 56 items, with global CVI calculated as 0.87. Conclusion: the final instrument presented content validity for data collection in head and neck clinic.

RESUMEN Objetivo: construir y validar el contenido de un instrumento para la recolección de datos de los pacientes con cáncer de cabeza y cuello (CCC) tratados en la especialidad ambulatoria. Método: estudio metodológico compuesto por cuatro etapas. La primera consistió en la elaboración del instrumento, utilizando bases de datos y el modelo teórico de Marjory Gordon. En la segunda y tercera etapas ocurrió la validación de contenido por ocho jueces enfermeros. Para la evaluación se utilizó el Índice de Validez del Contenido (IVC). En la cuarta etapa se llevó a cabo una prueba piloto con diecisiete pacientes con CCC. Resultados: de las 88 cuestiones formuladas y organizadas en las dimensiones de estructura y proceso sometidas a la validación, se excluyeron los ítems con IVC menor que 0,80. El instrumento final tuvo 56 ítems, obteniéndose cálculo de IVC global de 0,87. Conclusión: el instrumento final presentó validez de contenido para la recolección de datos en ambulatorio de cabeza y cuello.

RESUMO Objetivo: construir e validar conteúdo de um instrumento para levantamento de dados de pacientes com câncer de cabeça e pescoço (CCP) atendidos em ambulatório da especialidade. Método: estudo metodológico composto por quatro etapas. A primeira consistiu na elaboração do instrumento, utilizando-se bases de dados e o modelo teórico de Marjory Gordon. Na segunda e terceira etapas ocorreu a validação de conteúdo por oito juízes enfermeiros. Para avaliação foi utilizado o Índice de Validade do Conteúdo (IVC). Na quarta etapa foi realizado teste piloto com dezessete pacientes com CCP. Resultados: das 88 questões formuladas e organizadas nas dimensões de estrutura e processo submetidas à validação, foram excluídos os itens com IVC menor que 0,80. O instrumento final foi composto por 56 itens, obtendo-se cálculo de IVC global de 0,87. Conclusão: o instrumento final apresentou validade de conteúdo para a coleta de dados em ambulatório de cabeça e pescoço.

Assessment of reimbursement in a community hospital-based pharmacist-managed outpatient transition clinic.

PURPOSE: The assessment of reimbursement for and time spent on patient visits in a newly implemented, outpatient pharmacist-managed transition clinic (TC) was studied. METHODS: A retrospective chart review was conducted on clinic visits that occurred during January 1 to December 31, 2015. Patients who had at least one TC visit during the study period were included. Any visit with no response from insurance by March 31, 2016, was excluded. Services provided by the TC were billed using a facility fee billing model. The following data were collected: number of visits, time length of individual visits, billed amount, level of service, type of insurance, and amount reimbursed (from primary insurance, secondary insurance, and total amount). Data were analyzed using descriptive statistics. RESULTS: One hundred eight patients were eligible for inclusion in the study, with a total of 306 eligible visits. Each patient had a mean of 2.82 visits. The mean ± S.D. time spent per visit was 55 minutes. Visits were billed at level 2 (2%), level 3 (36%), and level 4 (62%). Two hundred seventy-two visits (89%) were partially or completely reimbursed by insurance, whereas 34 visits (11%) provided no reimbursement. The mean ± S.D. reimbursement was $99 ± $51.88 per visit. CONCLUSION: A pharmacist-managed TC service based in a community hospital achieved a positive return on investment through insurer reimbursement over a 12-month period.

Improving Medication Adherence in Patients with Hypertension: A Randomized Trial.

BACKGROUND AND PURPOSE: In patients with hypertension, medication adherence is often suboptimal, thereby increasing the risk of ischemic heart disease and stroke. In a randomized trial, we investigated the effectiveness of a multifaceted pharmacist intervention in a hospital setting to improve medication adherence in hypertensive patients. Motivational interviewing was a key element of the intervention. METHODS: Patients (n = 532) were recruited from 3 hospital outpatient clinics and randomized to usual care or a 6-month pharmacist intervention comprising collaborative care, medication review, and tailored adherence counseling including motivational interviewing and telephone follow-ups. The primary outcome was composite medication possession ratio (MPR) to antihypertensive and lipid-lowering agents, at 1-year follow-up, assessed by analyzing pharmacy records. Secondary outcomes at 12 months included persistence to medications, blood pressure, hospital admission, and a combined clinical endpoint of cardiovascular death, stroke, or acute myocardial infarction. RESULTS: At 12 months, 20.3% of the patients in the intervention group (n = 231) were nonadherent (MPR <0.80), compared with 30.2% in the control group (n = 285) (risk difference -9.8; 95% confidence interval [CI], -17.3, -2.4) and median MPR (interquartile range) was 0.93 (0.82-0.99) and 0.91 (0.76-0.98), respectively, P = .02. The combined clinical endpoint was reached by 1.3% in the intervention group and 3.1% in the control group (relative risk 0.41; 95% CI, 0.11-1.50). No significant differences were found for persistence, blood pressure, or hospital admission. CONCLUSIONS: A multifaceted pharmacist intervention in a hospital setting led to a sustained improvement in medication adherence for patients with hypertension. The intervention had no significant impact on blood pressure and secondary clinical outcomes.

Heart Failure in a Dedicated Outpatient Clinic: Results after 58 Month Follow-Up. Can it be Enough?

Incidence of chronic heart failure (HF) is rapidly increasing, approaching a 10 per 1000 rate after 65 years of age. In the last decades, despite pharmacological, interventional and supportive innovations, HF prognosis remained poor, with about 30% of death within one year from the diagnosis. Current guidelines recommend for these patients management programs providing follow-up through dedicated outpatient clinic. Limits of these programs are represented by great difficulties in getting patients adherence, being still too elevated the rate of abandonments. In this paper, we analyzed the impact of 58 months of activity in our dedicated to heart failure outpatient clinic on mortality, hospitalization and abandonment rate. 477 HF patients (346 M, 72.5%, mean age 69.6 years) were enrolled. Mean follow-up and visit were 18.2 and 2.6 months respectively. Total mortality rate was 11.5%, 4% of patients per year. Total hospitalizations for acute HF were 212 and, among all patients left in follow-up, the number of hospitalizations for acute de-compensation significantly decreased from 0.49/patient/year before enrollment to 0.29/patient/year during follow-up (p=0.015). Patients who abandoned outpatient clinic were 94 (19%, 1 abandonment every 23 days), mostly observed over the first months of activity. In conclusion, our patients experienced a major decrease in rates of acute de-compensation and need of in-hospital admissions.

Noninterventional observational study using high-dose controlled-release oxycodone (CR oxycodone) for cancer pain management in outpatient clinics.

PURPOSE: Efficacy, safety, and quality of life (QoL) for patients receiving larger doses of controlled-release oxycodone (CR oxycodone) in outpatient clinics are evaluated. METHODS: The use of high-dose CR oxycodone and adjuvant drugs for pain management, pain intensity, parameters associated with quality of life, and adverse effects in cancer patients treated with high-dose CR oxycodone (≥80 mg/day) was prospectively observed for 8 weeks. Data from 486 cancer patients receiving high-dose CR oxycodone were collected from 44 hospitals during the period from February 2009 to March 2010. RESULTS: Three hundred eighteen of the total 486 patients treated with high-dose CR oxycodone were followed up for 8 weeks. Pain intensity significantly improved from a mean numeric rating scale (NRS) 5.49 to NRS 4.33 (P < 0.0001). Dosage of CR oxycodone increased from a mean of 130.0 to a mean of 174.9 (P < 0.0001). QoL including activity, walking, and sleeping significantly improved after 8 weeks. At baseline, 138 complained of adverse effects, of which constipation (30.2%) was the most common followed by dry mouth (8.8%) and dizziness (8.2%). After 8 weeks, 128 patients complained of adverse effects such as constipation (27.0%), nausea (5.7%), dry mouth (5.7%), and dizziness (5.0%). After 8 weeks of high-dose CR oxycodone, adverse effects did not increase. CONCLUSION: This study suggests that over an 8-week period, the use of high-dose CR oxycodone for cancer pain management is efficient, safe, and tolerable in outpatient clinics.