Primary care needs of children with hydrocephalus

Objective. To determine the roles of primary care physicians and specialists in the medical care of children with serious heart disease. Setting. Pediatric Cardiology Division; Tertiary Care Children's Hospital. Subjects. Convenience sample of parents, primary care physicians, and pediatric cardiologists of 92 children with serious heart disease. Design. Questionnaire study; questionnaires based on 16 medical care needs, encompassing basic primary care services, care specific to the child's heart disease and general issues related to chronic illness. Results. All children had a primary care physician (PCP), and both they and the parents (P) reported high utilization of PCP for basic primary care services. However, there was little involvement of PCP in providing care for virtually any aspect of the child's heart disease. Parents expressed a low level of confidence in the ability of PCP in general or their child's own PCP to meet many of their child's medical care needs. Both PCP and pediatric cardiologists (PC) were significantly more likely than parents to see a role for PCP in providing for care specific to the heart disease as well as more general issues related to chronic illness. PC and PCP generally agreed about the role PCP should play, although PC saw a bigger role for PCP in providing advice about the child's activity than PCP themselves did. PC were less likely to see the PCP as able to follow the child for long term complications than PCP did. PC were more likely than PCP to believe that PCP were too busy or were inadequately reimbursed to care for children with serious heart disease. Only about one-third of parents reported discussing psychosocial, family, economic, or genetic issues with any provider, and PCP were rarely involved in these aspects of chronic illness. Conclusions. Primary care physicians do not take an active role in managing either the condition-specific or the more general aspects of this serious chronic childhood illness. With appropriate information and support from their specialist colleagues primary care physicians could provide much of the care for this group of children. Generalists and specialists are both responsible for educating and influencing parents about the role primary care physicians can play in caring for children with serious chronic illness.

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The Role of Emergency Medical Services in Geriatrics: Bridging the Gap between Primary and Acute Care

CJEM ◽

10.1017/cem.2015.73 ◽

2015 ◽

Vol 18 (1) ◽

pp. 54-61 ◽

Cited By ~ 8

Author(s):

Judah Goldstein ◽

Jennifer McVey ◽

Stacy Ackroyd-Stolarz

Keyword(s):

Older Adults ◽

Primary Care ◽

Emergency Medical Services ◽

Acute Care ◽

Functional Independence ◽

Adverse Outcomes ◽

Medical Services ◽

Care Needs ◽

Frail Older Adults ◽

Emergency Medical

AbstractCaring for older adults is a major function of emergency medical services (EMS). Traditional EMS systems were designed to treat single acute conditions; this approach contrasts with best practices for the care of frail older adults. Care might be improved by the early identification of those who are frail and at highest risk for adverse outcomes. Paramedics are well positioned to play an important role via a more thorough evaluation of frailty (or vulnerability). These findings may inform both pre-hospital and subsequent emergency department (ED) based decisions. Innovative programs involving EMS, the ED, and primary care could reduce the workload on EDs while improving patient access to care, and ultimately patient outcomes. Some frail older adults will benefit from the resources and specialized knowledge provided by the ED, while others may be better helped in alternative ways, usually in coordination with primary care. Discerning between these groups is a challenge worthy of further inquiry. In either case, care should be timely, with a focus on identifying emergent or acute care needs, frailty evaluation, mobility assessments, identifying appropriate goals for treatment, promoting functional independence, and striving to have the patient return to their usual place of residence if this can be done safely. Paramedics are uniquely positioned to play a larger role in the care of our aging population. Improving paramedic education as it pertains to geriatrics is a critical next step.

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Needs of patients with dementia and their caregivers in primary care: lessons learned from the Alzheimer plan of Quebec

BMC Family Practice ◽

10.1186/s12875-021-01528-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Vladimir Khanassov ◽

Laura Rojas-Rozo ◽

Rosa Sourial ◽

Xin Qiang Yang ◽

Isabelle Vedel

Keyword(s):

Primary Care ◽

Unmet Needs ◽

Social Care ◽

Phase 1 ◽

Lessons Learned ◽

Community Dwelling ◽

Care Plan ◽

Phase 2 ◽

Care Needs ◽

Health And Social Care

Abstract Background Persons living with dementia have various health and social care needs and expectations, some which are not fully met by health providers, including primary care clinicians. The Quebec Alzheimer plan, implemented in 2014, aimed to cover these needs, but there is no research on the effect this plan had on the needs and expectations of persons living with dementia. The objective of this study is to identify persons living with dementia and caregivers’ met and unmet needs and to describe their experience. Methods This is a sequential mixed methods explanatory design: Phase 1: cross-sectional study to describe the met and unmet health and social care needs of community-dwelling persons living with dementia using Camberwell Assessment of Need of the Elderly and Carers’ Assessment for Dementia tools. Phase 2: qualitative descriptive study to explore and understand the experiences of persons living with dementia and caregivers with the use of social and healthcare services, using semi-structured interviews. Data from phase 1 was analyzed with descriptive statistics, and from phase 2, with inductive thematic analysis. Results from phases 1 and 2 were compared, contrasted and interpreted together. Results The mean total number of needs reported by the patients was 5.03 (4.48 and 0.55 met and unmet needs, respectively). Caregivers had 0.52 met needs (3.16 unmet needs). The main needs for both were memory, physical health, eyesight/hearing/communication, medication, looking after home, money/budgeting. Three categories were mentioned by the participants: Persons living with dementia and caregiver’s attitude towards memory decline, their perception of community health services and of the family medicine practice. Conclusions Our study confirms the findings of other studies on the most common unmet needs of the patients and caregivers that are met partially or not at all. In addition, the participants were satisfied with access to care, and medical services in primary practices, being confident in their family. Our results indicate persons living with dementia and their caregivers need a contact person, a clear explanation of their dementia diagnosis, a care plan, written information on available services, and support for the caregivers.

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Refugee-like migrants have similar health needs to refugees: a New Zealand post-settlement cohort study

BJGP Open ◽

10.3399/bjgpopen20x101013 ◽

2020 ◽

Vol 4 (1) ◽

pp. bjgpopen20X101013

Author(s):

Jonathan Donald Kennedy ◽

Serena Moran ◽

Sue Garrett ◽

James Stanley ◽

Jenny Visser ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

New Zealand ◽

Primary Care Practice ◽

Social Care ◽

Hospital Admissions ◽

Outpatient Service ◽

Care Practice ◽

Care Needs ◽

Health And Social Care

BackgroundRefugees and asylum seekers have specific health and social care needs on arrival in a resettlement country. A third group — migrants with a refugee-like background (refugee-like migrants) — are less well defined or understood.AimUsing routinely collected data, this study compared demographics, interpreter need, and healthcare utilisation for cohorts of refugee-like migrants and refugees.Design & settingA retrospective cohort study was undertaken in Wellington, New Zealand.MethodData were obtained for refugee-like migrants and refugees accepted under the national quota system (quota refugees), who enrolled in a New Zealand primary care practice between 2011 and 2015. Data from the primary care practice and nationally held hospital and outpatient service databases, were analysed. Age and sex standardisation adjusted for possible differences in cohort demographic profiles.ResultsThe cohorts were similar in age, sex, deprivation, and interpreter need. Refugee-like migrants were found to have similar, but not identical, health and social care utilisation to quota refugees. Primary care nurse utilisation was higher for refugee-like migrants. Clinical entries in the primary care patient record were similar in rate for the cohorts. Emergency department utilisation and hospital admissions were similar. Hospital outpatient utilisation was lower for refugee-like migrants.ConclusionThis research suggests that health, social care, and other resettlement services should be aligned for refugee-like migrants and quota refugees. This would mean that countries accepting quota refugees should plan for health and social care needs of subsequent refugee-like migrant family migration. Further research should investigate matched larger-scale national health and immigration datasets, and qualitatively explore factors influencing health-seeking behaviour of refugee-like migrants.

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BEFORE THE TIPPING POINT: USING A COMPUTER RECORD SEARCH TO AID IDENTIFICATION OF PATIENTS WITH PALLIATIVE CARE NEEDS IN PRIMARY CARE

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2014-000654.34 ◽

2014 ◽

Vol 4 (Suppl 1) ◽

pp. A13.1-A13

Author(s):

Bruce Mason ◽

Kirsty Boyd ◽

Christine Campbell ◽

John Steyn ◽

Marilyn Kendall ◽

...

Keyword(s):

Primary Care ◽

Palliative Care ◽

Tipping Point ◽

Care Needs ◽

Palliative Care Needs

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Pediatric Problems in a Suburban Shelter for Homeless Families

PEDIATRICS ◽

10.1542/peds.85.1.33 ◽

1990 ◽

Vol 85 (1) ◽

pp. 33-38

Author(s):

Joel L. Bass ◽

Patricia Brennan ◽

Kishor A. Mehta ◽

Sally Kodzis

Keyword(s):

Primary Care ◽

Giardia Lamblia ◽

Enteric Pathogens ◽

Chronic Medical Conditions ◽

Homeless Families ◽

Care Needs ◽

Medical Problems ◽

Healthy Environment ◽

Medical Evaluation ◽

The Family

The experience of an affiliation between a hospital-based clinic and a family shelter is presented. The medical implications of family shelter residence include special issues related to the spread of infectious diseases, particularly to the neonate. Preentry medical evaluation revealed that a large proportion of children and their parents had one or more medical problems. Of 67 children screened before entrance, 3% had Giardia lamblia detected in the stool. In addition to carriage of enteric pathogens, the range of pediatric problems encountered included a variety of acute and chronic medical conditions, unmet primary care needs, and developmental and school difficulties. Fifty-eight percent of shelter residents were found to be "medically homeless." Formal liaison between a hospital-based clinic and a family shelter was found to be an effective way to promote a healthy environment in the family shelter and to provide needed medical services to shelter families.

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Supporting Goal-Oriented Primary Health Care for Seniors’ with Multimorbidity and Complex Care Needs using Mobile Technology: Mixed-Methods, Stepped-Wedge Cluster Randomized Trial of the ePRO Tool. (Preprint)

10.2196/preprints.29071 ◽

2021 ◽

Author(s):

Carolyn Steele Gray ◽

Phat (Eduard) Chau ◽

Farah Tahsin ◽

Sarah Harvey ◽

Mayura Loganathan ◽

...

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Control Period ◽

Self Management ◽

Care Needs ◽

Ethnographic Data ◽

Care Practices ◽

Primary Care Practices ◽

Complex Care Needs

BACKGROUND Goal-oriented care is being adopted to deliver person-centred primary care to older adults with multimorbidity and complex care needs. While this model holds promise, implementation remains a challenge. Digital health solutions may enable processes to improve adoption, however, they require evaluation to determine feasibility and impact. OBJECTIVE This study evaluates the implementation and effectiveness of the electronic Patient Reported Outcome (ePRO) mobile application and portal system, designed to enable goal-oriented care delivery in inter-professional primary care practices. The research questions driving this study are: 1) Does ePRO improve quality of life and self-management in older adults with complex needs, and 2) what mechanisms are likely driving observed outcomes? METHODS A multi-method pragmatic randomized control trial using a stepped-wedge design and ethnographic case studies was conducted over a 15-month period in 6 comprehensive primary care practices across Ontario with a target enrolment of 176 patients. The 6 practices were randomized into either early (3-month control period; 12-month intervention) or late (6-month control period; 9-month intervention) groups. The primary outcome measure of interest was the Assessment of Quality of Life-4D (AQoL-4D). Data were collected at baseline and at 3 monthly intervals for the duration of the trial. Ethnographic data included observations and interviews with patients and providers at the mid-point and end of the intervention. Outcome data were analyzed using linear models conducted at the individual level, accounting for cluster effects at the practice level, and ethnographic data was analyzed using qualitative description and framework analysis methods. RESULTS Recruitment challenges resulted in fewer sites and participants than expected; only 142 of the 176 eligible patients were identified due to lower than expected provider participation and fewer than expected patients willing to participate or perceived as ready to engage in goal setting. Of 142 patients approached, 45 patients participated (32%). Patients set a variety of goals related to self-management, mental health, social health and overall well-being. Due to underpowering, the impact of ePRO on quality of life could not be definitively assessed; however the intervention group, ePRO plus usual care (M = 15.28, SD = 18.60), demonstrated non-significant slight decrease in quality of life, t(24)= -1.20, P = 0.24, when compared to usual care only (M = 21.76, SD = 2.17). The ethnographic data reveals a complex implementation process, in which the meaningfulness (or coherence) of the technology to individuals lives and work acted as a key driver to adoption and tool appraisal. CONCLUSIONS This trial experienced many unexpected and significant implementation challenges related to recruitment and engagement. Future studies could be improved through better alignment of the research methods and intervention to the complex and diverse clinic settings, dynamic goal-oriented care process, and readiness of provider and patient participants. CLINICALTRIAL ClinicalTrials.gov NCT02917954; https://clinicaltrials.gov/ct2/show/NCT02917954?intr=epro&cntry=CA&rank=1

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