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1.
Niger Postgrad Med J ; 31(2): 163-169, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38826020

RESUMO

BACKGROUND: Interprofessional collaboration in healthcare is important to optimise healthcare delivery. However, relatively few studies have been conducted on the topic in Nigeria, especially in the North. OBJECTIVE: The objective of this study was to determine the levels of interprofessional collaboration, enablers and barriers amongst healthcare workers. MATERIALS AND METHODS: Data were collected using a five-domain modified Assessment of Interprofessional Team Collaboration Scale questionnaire, with a Likert scale of 1-5. The ideal mean score was ≤2 for the barriers domain and ≥4 for the other domains. Data were analysed using the Statistical Package for the Social Sciences (SPSS) version 23. RESULTS: Two hundred and sixty-six participants responded to the questionnaire. Male and female respondents were 131 (49.2%) each. Half of the respondents were 31 to 40 years old. One hundred and thirty-six (51.1%) of the respondents were nurses, and 48 (18.0%) were doctors. The modal working experience was 6-11 years (41.4%), and 117 (44.0%) respondents had at least a bachelor's degree. The mean scores for the domains were 4.1032 for partnership, 3.2383 for cooperation, 3.6309 for coordination, 4.2844 for enablers and 3.7902 for barriers. CONCLUSION: There was adequate level of partnership and enablers amongst the healthcare workers but insufficient cooperation and coordination and high level of barriers. Staff training on cooperation, coordination and identified barriers is necessary to improve interprofessional collaboration in the hospital.


Assuntos
Comportamento Cooperativo , Relações Interprofissionais , Centros de Atenção Terciária , Humanos , Nigéria , Masculino , Feminino , Adulto , Inquéritos e Questionários , Equipe de Assistência ao Paciente/organização & administração , Atitude do Pessoal de Saúde , Pessoa de Meia-Idade , Pessoal de Saúde/estatística & dados numéricos , Pessoal de Saúde/psicologia , Estudos Transversais , Adulto Jovem
3.
J Allied Health ; 53(2): e67-e76, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38834345

RESUMO

Parkinson's disease (PD) is a complex condition, and individuals living in rural areas often face challenges accessing the specialized care they require. To better understand the specific healthcare needs of individuals with PD in Eastern North Carolina (ENC), the present study investigated three key areas: access to a multidisciplinary care team, access to PD-specific resources, and access to resources for establishing telemedicine services. Participants were recruited through email invitations to Parkinson's Foundation members and the distribution of postcards in the region, and 106 individuals with PD in ENC completed the online survey. Only 28.3% of respondents reported access to an interdisciplinary care team, with approximately 50% stating that their healthcare provider had not informed them of the availability of such a team. Nevertheless, the quality of care received was generally perceived as high, and 41.5% of participants were part of a PD support group. Approximately half of the respondents expressed a willingness to have telemedicine appointments with a movement disorder specialist. These findings offer valuable insights for healthcare providers and policymakers in rural areas to better understand the needs of people with PD. Several strategies, including community building and increased access to telemedicine, are recommended to address these needs.


Assuntos
Acessibilidade aos Serviços de Saúde , Doença de Parkinson , Equipe de Assistência ao Paciente , Telemedicina , Humanos , North Carolina , Telemedicina/organização & administração , Doença de Parkinson/terapia , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Equipe de Assistência ao Paciente/organização & administração , Necessidades e Demandas de Serviços de Saúde , Adulto , População Rural , Idoso de 80 Anos ou mais
5.
Health Qual Life Outcomes ; 22(1): 44, 2024 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-38835030

RESUMO

BACKGROUND: Patients with inflammatory bowel disease (IBD) experience difficulties in daily life and demanding self-care needs. The goal of our support for patients is to ease their difficulties and improve their belief in their capacity to self-manage their disease (self-efficacy), by increasing their ability for self-care. The nurse's contribution is vital in empowering patients and supporting them to better manage their disease. There is evidence that higher nurse staffing levels are associated with better patient outcomes in acute care settings, but little is known about the outpatient setting. The objective of this study was to explore the impact of multidisciplinary team care with abundant nurse staffing levels on patient-reported outcome measures (PROMs) among patients with IBD, encompassing Crohn's disease (CD) and ulcerative colitis (UC), in clinical remission. METHODS: Patients with IBD in clinical remission were included because disease activity influences the patient's subjective evaluation. A total of 499 valid responses from two different sources were analyzed: 318 from a specialized IBD clinic with abundant nurse staffing and a multidisciplinary care team (UC: 83, CD: 235) and 181 from an online survey panel (UC: 109, CD: 72). The IBD Self-Efficacy Scale (IBD-SES) and the difficulty of life scale (DLS) were used as disease-specific PROMs. RESULTS: In two multiple regression models adjusted by background characteristics (age, sex, diagnosis [UC/CD], employment status, use of biologics, and disease duration) using the IBD-SES or DLS as a dependent variable, the responses from clinic patients showed a more favorable score (higher self-efficacy or lower difficulty) than the online responses. CONCLUSIONS: Multidisciplinary team care with abundant nurse staffing may improve self-efficacy and ease difficulties of life among patients with IBD in clinical remission. These results could help bring attention to nurse staffing in an outpatient setting, which has previously been overlooked, and be the first to provide evidence of its importance in encouraging enhanced staffing levels.


Assuntos
Doenças Inflamatórias Intestinais , Equipe de Assistência ao Paciente , Medidas de Resultados Relatados pelo Paciente , Humanos , Feminino , Masculino , Adulto , Equipe de Assistência ao Paciente/organização & administração , Pessoa de Meia-Idade , Doenças Inflamatórias Intestinais/terapia , Doenças Inflamatórias Intestinais/psicologia , Doenças Inflamatórias Intestinais/enfermagem , Inquéritos e Questionários , Autoeficácia , Qualidade de Vida , Colite Ulcerativa/terapia , Doença de Crohn/terapia , Doença de Crohn/psicologia , Admissão e Escalonamento de Pessoal
6.
Support Care Cancer ; 32(7): 414, 2024 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-38842641

RESUMO

PURPOSE: Many patients living beyond cancer experience significant unmet needs, although few of these patients are currently reviewed by specialist palliative care teams (SPCTs). The aim of this narrative review was to explore the current and potential role of SPCTs in this cohort of patients. METHODS: A search strategy was developed for Medline, and adapted for Embase, CINAHL, and PsycInfo. Additionally, websites of leading oncology, cancer survivorship, and specialist palliative care organisations were examined. The focus of the search was on individuals living beyond cancer rather than other groups of cancer survivors. RESULTS: 111 articles were retrieved from the search for full text review, and 101 other sources of information were identified after hand searching the reference lists of the full text articles, and the aforesaid websites. The themes of the review encompass the definition of palliative care/specialist palliative care, current models of specialist palliative care, core activities of SPCTs, relevant expertise of SPCTs, and potential barriers to change in relation to extending their support and expertise to individuals living beyond cancer. The review identified a paucity of evidence to support the role of SPCTs in the management of patients living beyond cancer. CONCLUSIONS: Individuals living beyond cancer have many unmet needs, and specific services are required to manage these problems. Currently, there is limited evidence to support the role of specialist palliative care teams in the management of this cohort of people, and several potential barriers to greater involvement, including limited resources, and lack of relevant expertise.


Assuntos
Cuidados Paliativos , Humanos , Cuidados Paliativos/métodos , Cuidados Paliativos/organização & administração , Sobreviventes de Câncer/psicologia , Neoplasias/terapia , Equipe de Assistência ao Paciente/organização & administração
7.
Can J Surg ; 67(3): E247-E249, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38843944

RESUMO

SummaryIn Canada, trauma patients often present initially to non-trauma hospitals without vascular surgeons on site. Local surgeons need skills and support for damage-control vascular surgery. Canadian training programs in general surgery should equip trainees with skills in this area, including resuscitation, identification of vascular injury, hemorrhage control, and temporizing measures (e.g., shunts, ligation). Caring for trauma patients is a multidisciplinary endeavour; understanding local/regional skill sets and from whom to seek help is vital. Opportunities for skills maintenance should also be encouraged for surgeons practising at sites where acutely injured patients present.


Assuntos
Equipe de Assistência ao Paciente , Procedimentos Cirúrgicos Vasculares , Humanos , Canadá , Procedimentos Cirúrgicos Vasculares/educação , Equipe de Assistência ao Paciente/organização & administração , Competência Clínica , Lesões do Sistema Vascular/cirurgia , Cirurgiões/educação
9.
Am J Med Qual ; 39(3): 123-130, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38713600

RESUMO

Current maternal care recommendations in the United States focus on monitoring fetal development, management of pregnancy complications, and screening for behavioral health concerns. Often missing from these recommendations is support for patients experiencing socioeconomic or behavioral health challenges during pregnancy. A Pregnancy Medical Home (PMH) is a multidisciplinary maternal health care team with nurse navigators serving as patient advocates to improve the quality of care a patient receives and health outcomes for both mother and infant. Using bivariate comparisons between PMH patients and reference groups, as well as interviews with project team members and PMH graduates, this evaluation assessed the impact of a PMH at an academic medical university on patient care and birth outcomes. This PMH increased depression screenings during pregnancy and increased referrals to behavioral health care. This evaluation did not find improvements in maternal or infant birth outcomes. Interviews found notable successes and areas for program enhancement.


Assuntos
Serviços de Saúde Materna , Assistência Centrada no Paciente , Melhoria de Qualidade , Humanos , Gravidez , Feminino , Assistência Centrada no Paciente/organização & administração , Melhoria de Qualidade/organização & administração , Serviços de Saúde Materna/normas , Serviços de Saúde Materna/organização & administração , Adulto , Qualidade da Assistência à Saúde/organização & administração , Resultado da Gravidez , Estados Unidos , Equipe de Assistência ao Paciente/organização & administração , Complicações na Gravidez/terapia
11.
J Nurs Educ ; 63(5): 304-311, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38729140

RESUMO

BACKGROUND: Health care reform promotes interprofessional patient-centric health care models associated with improved population health outcomes. Interprofessional education (IPE) programs are necessary to cultivate collaborative care, yet little evidence exists to support IPE pedagogy within nursing and other health science academia. METHOD: This quasiexperimental study examined differences in pre- and posttest Readiness for Interprofessional Learning Scale (RIPLS) scores following an IPE intervention. The IPE intervention consisted of a video presentation and a debriefing session after a simulated interprofessional collaborative patient care conference that introduced baccalaureate nursing and health science students to the roles and responsibilities of clinicians in team-based primary care. Pre- and postintervention RIPLS scores were analyzed. RESULTS: Pre- and postintervention RIPLS scores increased across all subscales, with distinct variation between nursing and health science student subscales. CONCLUSION: This IPE intervention had positive effects on students' readiness for interprofessional learning. Additional research is warranted to support health science pedagogy. [J Nurs Educ. 2024;63(5):304-311.].


Assuntos
Comportamento Cooperativo , Bacharelado em Enfermagem , Educação Interprofissional , Relações Interprofissionais , Estudantes de Enfermagem , Humanos , Educação Interprofissional/organização & administração , Estudantes de Enfermagem/psicologia , Estudantes de Enfermagem/estatística & dados numéricos , Bacharelado em Enfermagem/organização & administração , Feminino , Masculino , Pesquisa em Educação em Enfermagem , Equipe de Assistência ao Paciente/organização & administração , Adulto
12.
BMC Health Serv Res ; 24(1): 607, 2024 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-38724975

RESUMO

BACKGROUND: Primary health care has a central role in dementia detection, diagnosis, and management, especially in low-resource rural areas. Care navigation is a strategy to improve integration and access to care, but little is known about how navigators can collaborate with rural primary care teams to support dementia care. In Saskatchewan, Canada, the RaDAR (Rural Dementia Action Research) team partnered with rural primary health care teams to implement interprofessional memory clinics that included an Alzheimer Society First Link Coordinator (FLC) in a navigator role. Study objectives were to examine FLC and clinic team member perspectives of the impact of FLC involvement, and analysis of Alzheimer Society data comparing outcomes associated with three types of navigator-client contacts. METHODS: This study used a mixed-method design. Individual semi-structured interviews were conducted with FLC (n = 3) and clinic team members (n = 6) involved in five clinics. Data were analyzed using thematic inductive analysis. A longitudinal retrospective analysis was conducted with previously collected Alzheimer Society First Link database records. Memory clinic clients were compared to self- and direct-referred clients in the geographic area of the clinics on time to first contact, duration, and number of contacts. RESULTS: Three key themes were identified in both FLC and team interviews: perceived benefits to patients and families of FLC involvement, benefits to memory clinic team members, and impact of rural location. Whereas other team members assessed the patient, only FLC focused on caregivers, providing emotional and psychological support, connection to services, and symptom management. Face-to-face contact helped FLC establish a relationship with caregivers that facilitated future contacts. Team members were relieved knowing caregiver needs were addressed and learned about dementia subtypes and available services they could recommend to non-clinic clients with dementia. Although challenges of rural location included fewer available services and travel challenges in winter, the FLC role was even more important because it may be the only support available. CONCLUSIONS: FLC and team members identified perceived benefits of an embedded FLC for patients, caregivers, and themselves, many of which were linked to the FLC being in person.


Assuntos
Atenção Primária à Saúde , Serviços de Saúde Rural , Humanos , Atenção Primária à Saúde/organização & administração , Saskatchewan , Serviços de Saúde Rural/organização & administração , Feminino , Masculino , Doença de Alzheimer/terapia , Doença de Alzheimer/psicologia , Estudos Retrospectivos , Navegação de Pacientes/organização & administração , Pesquisa Qualitativa , Entrevistas como Assunto , Idoso , Equipe de Assistência ao Paciente/organização & administração
13.
BMC Prim Care ; 25(1): 162, 2024 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-38730368

RESUMO

BACKGROUND: Interprofessional primary care teams (IPCTs) work together to enhance care. Despite evidence on the benefits of IPCTs, implementation remains challenging. This research aims to 1) identify and prioritize barriers and enablers, and 2) co-develop team-level strategies to support IPCT implementation in Nova Scotia, Canada. METHODS: Healthcare providers and staff of IPCTs were invited to complete an online survey to identify barriers and enablers, and the degree to which each item impacted the functioning of their team. Top ranked items were identified using the sum of frequency x impact for each response. A virtual knowledge sharing event was held to identify strategies to address local barriers and enablers that impact team functioning. RESULTS: IPCT members (n = 117), with a mix of clinic roles and experience, completed the survey. The top three enablers identified were access to technological tools to support their role, standardized processes for using the technological tools, and having a team manager to coordinate collaboration. The top three barriers were limited opportunity for daily team communication, lack of conflict resolution strategies, and lack of capacity building opportunities. IPCT members, administrators, and patients attended the knowledge sharing event (n = 33). Five strategies were identified including: 1) balancing patient needs and provider scope of practice, 2) holding regular and accessible meetings, 3) supporting team development opportunities, 4) supporting professional development, and 5) supporting involvement in non-clinical activities. INTERPRETATION: This research contextualized evidence to further understand local perspectives and experiences of barriers and enablers to the implementation of IPCTs. The knowledge exchange event identified actionable strategies that IPCTs and healthcare administrators can tailor to support teams and care for patients.


Assuntos
Relações Interprofissionais , Equipe de Assistência ao Paciente , Atenção Primária à Saúde , Nova Escócia , Humanos , Atenção Primária à Saúde/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Inquéritos e Questionários , Comportamento Cooperativo , Masculino , Feminino , Disseminação de Informação/métodos , Adulto , Pessoal de Saúde
14.
J Bodyw Mov Ther ; 38: 211-253, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38763565

RESUMO

INTRODUCTION AND PURPOSE: Persistent musculoskeletal pain (PMP) is multifactorial and causes both societal and financial burdens. Integration of multifactorial management in patients with PMP remains challenging. A single-case experimental design was performed on three patients suffering from high impact PMP (lumbar spine, shoulder and knee) to i) assess the potential for Cognitive Functional Therapy (CFT) in interdisciplinary care, ii) describe in detail the clinical journey patients experienced during the intervention, and iii) evaluate the changes and associations in relation to the outcome measures of pain, disability, maladaptive movement behavior, subjective overall improvement, health related quality of life and work status. These were monitored over one year, at the end of each of the six intervention modules. RESULTS: After introducing the intervention systematic changes were seen, with medium to large changes (Non-overlap of All Pairs 0.67-1) for all outcome measures. Associations between changes of the outcome measures were large (r ≥ 0.50) and changes occurred concurrently. Minimally clinically important difference thresholds were exceeded for all outcome measures and two patients achieved relevant improvements related to work reintegration. DISCUSSION: The positive results of this study are comparable with recent CFT studies. However, the difference regarding the number of sessions and duration of the intervention is evident. The length of the intervention in this study seemed to enable continuous significant improvements up until 12 months post onset and follow-up. CONCLUSION: CFT in interdisciplinary care was effective for all measures. The detailed descriptions of the clinical processes aim to improve clinical care.


Assuntos
Terapia Cognitivo-Comportamental , Qualidade de Vida , Humanos , Feminino , Terapia Cognitivo-Comportamental/métodos , Masculino , Pessoa de Meia-Idade , Adulto , Dor Musculoesquelética/terapia , Dor Musculoesquelética/reabilitação , Dor Musculoesquelética/psicologia , Dor Crônica/terapia , Dor Crônica/psicologia , Dor Crônica/reabilitação , Equipe de Assistência ao Paciente/organização & administração
15.
J Nurs Adm ; 54(6): 333-340, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38767524

RESUMO

OBJECTIVE: To examine the extent to which Veterans Health Administration (VHA) Patient-Aligned Care Team (PACT) members have a shared understanding/ agreement upon and enact responsibilities within the team. BACKGROUND: The PACT model focuses on team-based care management. However, lack of a shared understanding of team-based care management roles and responsibilities makes system-wide implementation a challenge. METHODS: Quantitative and qualitative analysis of national survey data collected in 2022 from primary care personnel working in a VHA-affiliated primary care facility. RESULTS: Significant discrepancies exist in responses about what core team members say they do and what others perceive they should be doing, indicating either a lack of agreement, knowledge, or training about what core team members should do. CONCLUSIONS: Successful implementation of a team-based model requires adequate support and training for teamwork including shared mental models to work according to their clinical competency. Clear guidance and communication of expectations are critical for role clarity.


Assuntos
Equipe de Assistência ao Paciente , Assistência Centrada no Paciente , Atenção Primária à Saúde , United States Department of Veterans Affairs , Humanos , Estados Unidos , Equipe de Assistência ao Paciente/organização & administração , Atitude do Pessoal de Saúde , Masculino , Feminino
16.
BMC Health Serv Res ; 24(1): 617, 2024 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-38730416

RESUMO

BACKGROUND: Efficient planning of the oral health workforce in Primary Health Care (PHC) is paramount to ensure equitable community access to services. This requires a meticulous examination of the population's needs, strategic distribution of oral health professionals, and effective human resource management. In this context, the average time spent on care to meet the needs of users/families/communities is the central variable in healthcare professional workforce planning methods. However, many time measures are solely based on professional judgment or experience. OBJECTIVE: Calculate the average time parameters for the activities carried out by the oral health team in primary health care. METHOD: This is a descriptive observational study using the time-motion method carried out in five Primary Health Care Units in the city of São Paulo, SP, Brazil. Direct and continuous observation of oral health team members occurred for 40 h spread over five days of a typical work week. RESULTS: A total of 696.05 h of observation were conducted with 12 Dentists, three Oral Health Assistants, and five Oral Health Technicians. The Dentists' main activity was consultation with an average duration of 24.39 min, which took up 42.36% of their working time, followed by documentation with 12.15%. Oral Health Assistants spent 31.57% of their time on infection control, while Oral Health Technicians spent 22.37% on documentation. CONCLUSION: The study establishes time standards for the activities performed by the dental care team and provides support for the application of workforce planning methods that allow for review and optimization of the work process and public policies.


Assuntos
Atenção Primária à Saúde , Estudos de Tempo e Movimento , Humanos , Atenção Primária à Saúde/organização & administração , Brasil , Equipe de Assistência ao Paciente/organização & administração , Saúde Bucal
17.
Support Care Cancer ; 32(5): 324, 2024 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-38700723

RESUMO

PURPOSE: To identify elements of timely integration of palliative care (PC) into hospital oncology care from best practices. Thereafter, to assess the level of consensus among oncology and PC specialists and patient and relative representatives on the characteristics of timely integration of PC. METHODS: A three-round modified Delphi study was conducted. The expert panel consisted of 83 healthcare professionals (HCPs) from 21 Dutch hospitals (43 physicians, 40 nurses), 6 patient and 2 relative representatives. In the first round, four elements of integrated PC were considered: (1) identification of potential PC needs, (2) advance care planning (ACP), (3) routine symptom monitoring and (4) involvement of the specialist palliative care team (SPCT). In subsequent rounds, the panellists assessed which characteristics were triggers for initiating an element. A priori consensus was set at ≥ 70%. RESULTS: A total of 71 (78%) panellists completed the first questionnaire, 65 (71%) the second and 49 (54%) the third. Panellists agreed that all patients with incurable cancer should have their PC needs assessed (97%), symptoms monitored (91%) and ACP initiated (86%). The SPCT should be involved at the patient's request (86%) or when patients suffer from increased symptom burden on multiple dimensions (76%). Patients with a life expectancy of less than 3 months should be offered a consultation (71%). CONCLUSION: The expert panel agreed that timely integration of PC into oncology is important for all patients with incurable cancer, using early identification, ACP and routine symptom monitoring. Involvement of the SPCT is particularly needed in patients with multidimensional symptom burden and in those nearing death.


Assuntos
Técnica Delphi , Neoplasias , Cuidados Paliativos , Humanos , Cuidados Paliativos/métodos , Cuidados Paliativos/organização & administração , Neoplasias/terapia , Masculino , Países Baixos , Feminino , Pessoa de Meia-Idade , Inquéritos e Questionários , Planejamento Antecipado de Cuidados/organização & administração , Adulto , Prestação Integrada de Cuidados de Saúde/organização & administração , Prestação Integrada de Cuidados de Saúde/métodos , Consenso , Fatores de Tempo , Equipe de Assistência ao Paciente/organização & administração
18.
BMC Health Serv Res ; 24(1): 567, 2024 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-38698483

RESUMO

BACKGROUND: There is a growing recognition of multidisciplinary practices as the most rational approach to providing better and more efficient healthcare services. Pharmacists are increasingly integrated into primary care teams, but there is no universal approach to implementing pharmacist services across healthcare settings. In Norway, most pharmacists work in pharmacies, with very few employed outside this traditional setting. The home care workforce is primarily made up of nurses, assistant nurses, and healthcare assistants. General practitioners (GPs) are not based in the same location as home care staff. This study utilized the Normalization Process Theory (NPT) to conduct a process evaluation of the integration of pharmacists in a Norwegian home care setting. Our aim was to identify barriers and facilitators to optimal utilization of pharmacist services within a multidisciplinary team. METHODS: Semi-structured interviews (n = 9) were conducted with home care unit leaders, ward managers, registered nurses, and pharmacists in Norway, in November 2022-February 2023. Constructs from the NPT were applied to qualitative data. RESULTS: Findings from this study pertain to the four constructs of the NPT. Healthcare professionals struggled to conceptualize the pharmacists' competencies and there were no collectively agreed-upon objectives of the intervention. Consequently, some participants questioned the necessity of pharmacist integration. Further, participants reported conflicting preferences regarding how to best utilize medication-optimizing services in everyday work. A lack of stakeholder empowerment was reported across all participants. Moreover, home care unit leaders and managers reported being uninformed of their roles and responsibilities related to the implementation process. However, the presence of pharmacists and their services were well received in the setting. Moreover, participants reported that pharmacists' contributions positively impacted the multidisciplinary practice. CONCLUSION: Introducing new work methods into clinical practice is a complex task that demands expertise in implementation. Using the NTP model helped pinpoint factors that affect how pharmacists' skills are utilized in a home care setting. Insights from this study can inform the development of tailored implementation strategies to improve pharmacist integration in a multidisciplinary team.


Assuntos
Serviços de Assistência Domiciliar , Entrevistas como Assunto , Equipe de Assistência ao Paciente , Farmacêuticos , Pesquisa Qualitativa , Humanos , Serviços de Assistência Domiciliar/organização & administração , Noruega , Equipe de Assistência ao Paciente/organização & administração , Masculino , Feminino , Papel Profissional , Atitude do Pessoal de Saúde , Adulto , Pessoa de Meia-Idade
19.
Am J Manag Care ; 30(5): e165-e168, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38748917

RESUMO

OBJECTIVES: Given the problematic fragmentation of care for patients with end-stage kidney disease (ESKD), a kidney care organization and an integrated health system within a large accountable care organization partnered to best utilize their individual capabilities to collaborate around their shared patients in a coordinated care approach. Ultimately, the goal of the program is to allow care teams to achieve the triple aim of improving the patient experience, improving clinical outcomes, and reducing the total cost of health care. STUDY DESIGN: This is a retrospective examination of the first year of the Shared Patient Care Coordination (SPCC) program. METHODS: The analysis consisted of 2 parts. First, rates of hospitalizations and emergency department visits were compared between the SPCC patients and other patients of the integrated health system who had ESKD but did not participate in SPCC. Second, rates of clinical indicators-central venous catheter (CVC) use, home dialysis, advance care planning, and missed dialysis treatments-were benchmarked vs normative data taken by bootstrap sampling of the kidney care organization's patient population. RESULTS: Overall, dialysis patients participating in the SPCC program had a 15% lower rate of hospital admissions than those not participating ( P = .02). Additionally, the bootstrap analysis showed that by the second year, dialysis patients in the program had favorable rates (above the 95th percentile) of CVC use, dialysis treatment absenteeism, and completion of advance care plans. CONCLUSIONS: Enhanced and structured communication between dialysis providers and patient care teams provides a unique opportunity to coordinate patient-centered care and improve patient outcomes.


Assuntos
Falência Renal Crônica , Humanos , Falência Renal Crônica/terapia , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Hospitalização/estatística & dados numéricos , Idoso , Organizações de Assistência Responsáveis/estatística & dados numéricos , Diálise Renal , Equipe de Assistência ao Paciente/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração
20.
Am J Manag Care ; 30(6 Spec No.): SP437-SP444, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38820184

RESUMO

OBJECTIVES: Challenges in implementing telemedicine disproportionately affect patients served in safety-net settings. Few studies have elucidated pragmatic, team-based strategies for successful telemedicine implementation in primary care, especially with a safety-net population. STUDY DESIGN: We conducted in-depth, semistructured qualitative interviews with primary care clinicians and staff in a large urban safety-net health care system on the facilitators, challenges, and impact of implementing team workflows for synchronous telemedicine video and audio-only visits. METHODS: Interviews were analyzed using modified grounded theory with multistage coding. Common themes were identified and reviewed to describe within-group and between-group variations. We used the Practical, Robust Implementation Sustainability Model framework to organize the final themes with an implementation science lens. RESULTS: Four themes emerged from 11 interviews: (1) having a dedicated individual preparing patients for video visits is a prerequisite for the successful introduction of video visits to patients with limited digital literacy; (2) health care maintenance during video and audio-only visits benefits from standardized workflows and communication; (3) the increased flexibility and accessibility of telemedicine visits were perceived benefits to patient care, despite barriers for subsets of patients; and (4) telemedicine visits generally have a positive impact on work experience for clinicians and staff due to increased efficiency, despite audio-only visits feeling less engaging. CONCLUSIONS: Understanding how to strategically use team-based workflows to expand video visit access while ensuring care quality of all telemedicine visits will allow primary care practices to maximize telemedicine's benefits to patients in the safety-net setting.


Assuntos
Atenção Primária à Saúde , Provedores de Redes de Segurança , Telemedicina , Fluxo de Trabalho , Humanos , Telemedicina/organização & administração , Atenção Primária à Saúde/organização & administração , Provedores de Redes de Segurança/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Pesquisa Qualitativa , Feminino , Entrevistas como Assunto , Masculino , Adulto
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