Promoting Patient and Family Partnerships in Ambulatory Care Improvement: A Narrative Review and Focus Group Findings

Abstract Background: Trauma is one of the leading causes of mortality across the world. Trauma patients had critical status and need timely, adequate and organized care. The different consequences of trauma care among service centers around the world and even within a country reveal the need for care assessment. This study was designed and executed to collect experts’ opinion on the evaluation of trauma care in Iran. Methods: This qualitative study with conventional content analysis approach, two focus group discussions with 12 participants and 16 face-to-face in-depth interviews were conducted to collect the required data. Participants were selected through purposive sampling method. The experts’ viewpoints were classified in accordance with the main and sub themes. Results: Four basic themes extracted from the interviews and focus group discussion including, trauma care importance (sub-themes: the involved Individuals’ being young and productive and the effectiveness of trauma care); trauma care indicators (sub-themes: pre-hospital indicators, in-hospital indicators and post-hospital indicators); stages of trauma care evaluation (sub-themes: evaluation prerequisites, finalization of indicators prior to evaluation, determining evaluation time scope, determining evaluation dimensions, monitoring and evaluation and use of evaluation results); trauma care promotion (sub-themes: balancing workload in trauma centers, enhancement of information system, considering extra-organizational dimensions in trauma care and empowerment of trauma care providers). Conclusion: Performance evaluation through acceptable indicators is basis of health care improvement. In addition to the evaluation, reforming macro policies, development of infrastructures, enhancement of information system and training care providers should be taken into account too. Keywords: Performance indicators, Evaluation, Hospital, Trauma care

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Regional variations of perceived problems in ambulatory care from the perspective of general practitioners and their patients - an exploratory focus group study in urban and rural regions of northern Germany

BMC Family Practice ◽

10.1186/s12875-017-0637-x ◽

2017 ◽

Vol 18 (1) ◽

Cited By ~ 7

Author(s):

H. Hansen ◽

N. J. Pohontsch ◽

L. Bole ◽

I. Schäfer ◽

M. Scherer

Keyword(s):

Focus Group ◽

Ambulatory Care ◽

General Practitioners ◽

Northern Germany ◽

Focus Group Study ◽

Rural Regions ◽

Regional Variations

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Using EMR-enabled computerized decision support systems to reduce prescribing of potentially inappropriate medications: a narrative review

Therapeutic Advances in Drug Safety ◽

10.1177/2042098618784809 ◽

2018 ◽

Vol 9 (9) ◽

pp. 559-573 ◽

Cited By ~ 24

Author(s):

Ian A. Scott ◽

Peter I. Pillans ◽

Michael Barras ◽

Christopher Morris

Keyword(s):

Decision Support ◽

Decision Support Systems ◽

Ambulatory Care ◽

Outcome Measures ◽

Older Patients ◽

Support Systems ◽

Narrative Review ◽

Residential Aged Care ◽

Potentially Inappropriate Medications ◽

Inappropriate Medications

Prescribing of potentially inappropriate medications (PIMs) that pose more risk than benefit in older patients is a common occurrence across all healthcare settings. Reducing such prescribing has been challenging despite multiple interventions, including educational campaigns, audits and feedback, geriatrician assessment and formulary restrictions. With the increasing uptake of electronic medical records (EMRs) across hospitals, clinics and residential aged care facilities (RACFs), integrated with computerized physician order entry (CPOE) and e-prescribing, opportunities exist for incorporating clinical decision support systems (CDSS) into EMR at the point of care. This narrative review assessed the process and outcomes of using EMR-enabled CDSS to reduce the prescribing of PIMs. We searched PubMed for relevant articles published up to January 2018 and focused on those that described EMR-enabled CDSS that assisted prescribers to make changes at the time of ordering PIMs in adults. Computerized systems offering only medication reconciliation, dose checks, monitoring for medication errors, or basic formulary information were not included. In addition to outcome measures of medication-related processes and adverse drug events, qualitative data relating to factors that influence effectiveness of EMR-enabled CDSS were also gathered from selected studies. We analysed 20 studies comprising 10 randomized trials and 10 observational studies performed in hospitals ( n = 8), ambulatory care clinics ( n = 9) and RACFs ( n = 3). Studies varied in patient populations (although most involved older patients), type of CDSS, method of linkage with EMR, study designs and outcome measures. However, assuming little publication bias, the totality of evidence favoured EMR-enabled CDSS as being effective in reducing the prescribing of PIMs in hospitals, although results were more mixed for ambulatory care settings and RACFs. While absolute effects in most positive studies were modest, they suggest EMR-enabled CDSS are feasible and acceptable to clinicians, and if certain design features are adhered to, there is potential for even greater impact.

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Assessing the value of electronic prescribing in ambulatory care: A focus group study

International Journal of Medical Informatics ◽

10.1016/j.ijmedinf.2009.03.007 ◽

2009 ◽

Vol 78 (9) ◽

pp. 571-578 ◽

Cited By ~ 35

Author(s):

Saul N. Weingart ◽

Michael Massagli ◽

Adrienne Cyrulik ◽

Thomas Isaac ◽

Laurinda Morway ◽

...

Keyword(s):

Focus Group ◽

Ambulatory Care ◽

Electronic Prescribing ◽

Focus Group Study

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A hétévesnél fiatalabb gyermeket nevelő szülők háziorvosokkal való elégedettsége Magyarországon

Orvosi Hetilap ◽

10.1556/650.2015.30189 ◽

2015 ◽

Vol 156 (31) ◽

pp. 1253-1260

Author(s):

Bálint Bánfai ◽

Krisztina Deutsch ◽

Melinda Petőné Csima ◽

Sára Jeges ◽

Dóra Domina-Tancsics ◽

...

Keyword(s):

Primary Care ◽

Early Childhood ◽

Focus Group ◽

Waiting Time ◽

Parental Satisfaction ◽

Focus Group Interviews ◽

Group Interviews ◽

N 93 ◽

Care Improvement ◽

Child Evaluation

Introduction: Development of children’s primary care may only take place through proper monitoring of both providers and recipients. Aim: The aim of the study was to investigate the parental satisfaction with the doctor of 0–7 years old children. Method: The research took place in Budapest and five Hungarian counties in “Early Childhood (0–7 years) Programme 6.1.4/12/1-2012-0001”. There were 980 parental questionnaires were evaluated and 93 parents participated in ten focus group interviews (n = 93). Results: Answers indicated that parents were most satisfied with the information received from the physician of their child (score 3.8), and they were least satisfied with the waiting time and the time of consulting hours (score 3.4). The results of focus group interviews were similar to those obtained from the questionnaire survey. Conclusions: Participating parents are “rather satisfied” or “satisfied” with the physician of their child. Evaluation of the results forms basis to create indicators for primary care improvement. Orv. Hetil., 2015, 156(31), 1253–1260.

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Essential to increase the use of generics in Europe to maintain comprehensive health care?

Farmeconomia Health economics and therapeutic pathways ◽

10.7175/fe.v13i3s.312 ◽

2012 ◽

Vol 13 (3S) ◽

pp. 5-20 ◽

Cited By ~ 16

Author(s):

Brian Godman ◽

Marion Bennie ◽

Christoph Baumgärtel ◽

Ljiljana Sović-Brkičić ◽

Thomas Burkhardt ◽

...

Keyword(s):

Health Care ◽

Ambulatory Care ◽

Supply And Demand ◽

Narrative Review ◽

Demand Side ◽

Case Histories ◽

Comprehensive Health Care ◽

Comprehensive Health ◽

Innovative Drugs ◽

Ageing Populations

INTRODUCTION: Reforms have been introduced across Europe to increase prescribing efficiency with existing drugs. These include measures to lower prices of generics as well as increase their prescribing versus originators and patented products in a class or related class. This is essential to maintain comprehensive health care in Europe given continued pressures. The alternative is insufficient funds for new innovative drugs and increasing drug volumes with ageing populations. OBJECTIVE: To review the influence of measures and initiatives to increase the prescribing and dispensing of generics at low prices on ambulatory care prescribing efficiency. In view of this, provide guidance as authorities strive to introduce further reforms to meet their goals. METHODOLOGY: A narrative review of published papers combined with case histories. RESULTS: The different supply- and demand-side measures have reduced generic prices to as low as 2% to 3% of pre-patent loss prices in some cases as well as appreciably enhanced their utilisation. As a result, prescribing efficiency has increased without compromising care. In some cases, the reforms have led to expenditure actually falling despite appreciably increased volumes. CONCLUSIONS: Increasing use of generics at low prices will help maintain the European ideals of comprehensive and equitable health care. However, countries will continually need to learn from each other.

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A narrative review of ambulatory care education in Canadian internal medicine

Canadian Medical Education Journal ◽

10.36834/cmej.69333 ◽

2020 ◽

Author(s):

Gillian Spiegle ◽

Penny Yin ◽

Sarah Wright ◽

Stella Ng ◽

Tara O'Brien ◽

...

Keyword(s):

Internal Medicine ◽

Ambulatory Care ◽

Medical Training ◽

Narrative Review ◽

Internal Medicine Training ◽

Care Education ◽

Training Structures ◽

Relative Paucity ◽

Ovid Medline ◽

Societal Needs

Background: The Canadian healthcare system faces increasing patient volumes and complexity amidst funding constraints. Ambulatory care offers a potential solution to some of these challenges. Despite growing emphasis on the provision of ambulatory care, there has been a relative paucity of ambulatory care training curricula within Canadian internal medicine residency programs. We conducted a narrative review to understand the current state of knowledge on postgraduate ambulatory care education (ACE), in order to frame a research agenda for Canadian Internal Medicine ACE. Methods: We searched OVID Medline, Embase, and PsycINFO for articles that included the concepts of ambulatory care and medical or health professions education from 2005-2015. After sorting for inclusion/exclusion, we analyzed 30 articles, looking for dominant claims about ACE in Internal Medicine literature. Results: We found three claims. First, ACE is considered to be a necessary component of medical training because of its distinction from inpatient learning environments. Second, current models of ambulatory care clinics do not meet residency education needs. Third, ACE presents opportunities to develop non-medical expert roles. Conclusions: The findings of our narrative review highlight a need for additional research regarding ACE in Canada to inform optimal ambulatory internal medicine training structures and alignment of educational and societal needs.

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Description of Practice as an Ambulatory Care Nurse: Psychometric Properties of a Practice-Analysis Survey

Journal of Nursing Measurement ◽

10.1891/106137407780851787 ◽

2007 ◽

Vol 15 (1) ◽

pp. 62-76 ◽

Cited By ~ 8

Author(s):

Heibatollah Baghi ◽

Teresa L. Panniers ◽

Mary C. Smolenski

Keyword(s):

Focus Group ◽

Ambulatory Care ◽

Clinical Skills ◽

Management Skills ◽

Practice Analysis ◽

Client Care ◽

Five Factors ◽

Certification Examinations ◽

Nursing Demand ◽

Care Nursing

Changes within nursing demand that a specialty conduct periodic, appropriate practice analyses to continually validate itself against preset standards. This study explicates practice analysis methods using ambulatory care nursing as an exemplar. Data derived from a focus group technique were used to develop a survey that was completed by 499 ambulatory care nurses. The validity of the instrument was assessed using principal components analysis; reliability was estimated using Cronbach’s alpha coefficient. The focus group with ambulatory care experts produced 34 knowledge and activity statements delineating ambulatory care nursing practice. The survey data produced five factors accounting for 71% of variance in the data. The factors were identified as initial patient assessment, professional nursing issues and standards, client care management skills, technical/clinical skills, and system administrative operations. It was concluded that practice analyses delineate a specialty and provide input for certification examinations aimed at measuring excellence in a field of nursing.

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