Atlas of variance: healthcare professionals’ perception of key care delivery goals in patients with chronic intestinal failure in Europe

BackgroundCare bundles are sets of evidence-based interventions to improve quality of hospital care at admission and discharge. Within a wider multi-method evaluation of care bundles for adults with an emergency admission for acute exacerbations of chronic obstructive pulmonary disease, a qualitative study was conducted. The aim was to evaluate how bundles were used, and healthcare professionals’ experiences of the impact of bundles on the process of care delivery.MethodsWithin the wider evaluation, four acute hospitals that were using COPD care bundles were purposefully sampled for geographical variation. Qualitative data were gathered through non-participant observation of patient care and interviews with healthcare professionals, patients and carers. This paper reports a thematic analysis of data from observation and interviews with professionals.ResultsHealthcare professionals generally experienced care bundles as positive for standardising working practices and patient care, valuing how bundles could support a clear care pathway for patients, enable transitions between settings and identify postdischarge support required by patients. Successful use of bundles was perceived as more likely with the presence of either (or both) a clinical champion for bundles and system-based initiatives such as financial incentives, within a local culture of quality improvement. Challenges in accurately diagnosing COPD hampered bundle use, including delivery of bundles to those subsequently considered ineligible, or missed opportunities to deliver admission bundles to those with COPD.ConclusionCare bundles shape admission and discharge care processes for patients with COPD, from the perspective of staff involved in their delivery. However, different organisational, staff and clinical factors aid or hinder bundle use in an acute hospital context, suggesting potentially resolvable reasons for variable implementation of bundles. Finally, bundles may enhance staff experience of care delivery, even if the impact on patient outcomes remains uncertain.

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Understanding care when cure is not likely for young adults who face cancer: a realist analysis of data from patients, families and healthcare professionals

BMJ Open ◽

10.1136/bmjopen-2018-024397 ◽

2019 ◽

Vol 9 (1) ◽

pp. e024397 ◽

Cited By ~ 3

Author(s):

Charlotte Kenten ◽

Nothando Ngwenya ◽

Faith Gibson ◽

Mary Flatley ◽

Louise Jones ◽

...

Keyword(s):

Young Adults ◽

Healthcare Professionals ◽

Care Delivery ◽

Family Members ◽

Family Carers ◽

Structured Interviews ◽

Multiple Sources ◽

Programme Theory ◽

Realist Analysis ◽

Palliative Care Services

ObjectivesTo understand the experiences of young adults with cancer for whom cure is not likely, in particular what may be specific for people aged 16–40 years and how this might affect care.DesignWe used data from multiple sources (semi-structured interviews with people with cancer, nominated family members and healthcare professionals, and workshops) informed by a preliminary programme theory: realist analysis of data within these themes enabled revision of our theory. A realist logic of analysis explored contexts and mechanisms affecting outcomes of care.SettingThree cancer centres and associated palliative care services across England.ParticipantsWe aimed for a purposive sample of 45 people with cancer from two groups: those aged 16–24 years for whom there may be specialist cancer centres and those 16–40 years cared for through general adult services; each could nominate for interview one family member and one healthcare professional. We interviewed three people aged 16–24 years and 30 people 25–40 years diagnosed with cancer (carcinomas; blood cancers; sarcoma; central nervous system tumours) with a clinician-estimated prognosis of <12 months along with nominated family carers and healthcare professionals. 19 bereaved family members and 47 healthcare professionals participated in workshops.ResultsData were available from 69 interviews (33 people with cancer, 14 family carers, 22 healthcare professionals) and six workshops. Qualitative analysis revealed seven key themes: loss of control; maintenance of normal life; continuity of care; support for professionals; support for families; importance of language chosen by professionals; and financial concerns.ConclusionsCurrent care towards end of life for young adults with cancer and their families does not meet needs and expectations. We identified challenges specific to those aged 16–40 years. The burden that care delivery imposes on healthcare professionals must be recognised. These findings can inform recommendations for measures to be incorporated into services.

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Patients’ and healthcare professionals’ perceptions of self-management support interactions: Systematic review and qualitative synthesis

Chronic Illness ◽

10.1177/1742395317710082 ◽

2017 ◽

Vol 14 (2) ◽

pp. 79-103 ◽

Cited By ~ 24

Author(s):

Marika Franklin ◽

Sophie Lewis ◽

Karen Willis ◽

Helen Bourke-Taylor ◽

Lorraine Smith

Keyword(s):

Systematic Review ◽

Healthcare Professionals ◽

Care Delivery ◽

Individual Responsibility ◽

Self Management ◽

Chronic Obstructive ◽

Traditional Model ◽

Management Support ◽

Model Of Care ◽

Qualitative Synthesis

Objective To review studies examining the experience of self-management support in patient–provider interactions and the shaping of goals through interactions. Methods We undertook a systematic review and thematic synthesis of the qualitative literature. We searched six databases (2004–2015) for published studies on the provision of self-management support in one-to-one, face-to-face, patient–provider interactions for obesity, type 2 diabetes mellitus and chronic obstructive pulmonary disease, with 14 articles meeting inclusion criteria. Results Themes identified from studies were (1) dominance of a traditional model of care, encompassing the provision of generic information, exclusion of the psychosocial and temporal nature of interactions and (2) a context of individual responsibility and accountability, encompassing self-management as patients’ responsibility and adherence, accountability and the attribution of blame. Interactions were constrained by consultation times, patient self-blame and guilt, desire for autonomy and beliefs about what constitutes ‘effective’ self-management. Discussion Encounters were oriented towards a traditional model of care delivery and this limited opportunity for collaboration. These findings suggest that healthcare professionals remain in a position of authority, limiting opportunities for control to be shared with patients and shared understandings of social context to be developed.

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What do healthcare professionals want to know about intestinal failure and home parenteral nutrition?

Proceedings of The Nutrition Society ◽

10.1017/s0029665108007349 ◽

2008 ◽

Vol 67 (OCE3) ◽

Author(s):

K. Farrer ◽

A. Culkin

Keyword(s):

Parenteral Nutrition ◽

Healthcare Professionals ◽

Intestinal Failure ◽

Home Parenteral Nutrition

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Burnout em Profissionais da Saúde Portugueses: Uma Análise a Nível Nacional

Acta Médica Portuguesa ◽

10.20344/amp.6460 ◽

2016 ◽

Vol 29 (1) ◽

pp. 24 ◽

Cited By ~ 13

Author(s):

João Marôco ◽

Ana Lúcia Marôco ◽

Ema Leite ◽

Cristina Bastos ◽

Maria José Vazão ◽

...

Keyword(s):

Working Conditions ◽

Health Professionals ◽

Healthcare Professionals ◽

Care Delivery ◽

National Level ◽

Maslach Burnout Inventory ◽

Well Being ◽

Burnout Syndrome ◽

Ordinal Scale ◽

Personalized Health

Introduction: Burnout is a psychological syndrome, characterized by a state of high emotional exhaustion, high depersonalization and low personal accomplishment, which leads to erosion of personal, professional and health values. This study reports the incidence of burnout in Portuguese Healthcare professionals. Material and Methods: Burnout in Portugal’s health professionals was assessed with the Maslach Burnout Inventory - Human Services Survey, using a zero (never) to six (always) ordinal scale, on a sample of 1 262 nurses and 466 physicians with mean age of 36.8 year (SD = 12.2) and 38.7 (SD = 11.0), respectively. Participants came from all national districts (35% Lisbon, 18% Oporto, 6% Aveiro, 6% Setúbal, 5% Coimbra, 5% Azores and Madeira), working in hospitals (54%), Families’ Health Units (30%), Personalized Health Units (8%) and other public or private institutions (8%). Results: Analysis of MBI-HSS scores, stratified by district, revealed that both types of professionals had moderate to high levels of burnout (M = 3.0, SD = 1.7) with no significant differences between the two groups. Vila Real (M = 3.8, SD = 1.7) and Madeira (M = 2.5, SD = 1.5) were the regions where burnout levels were higher and lower, respectively. Burnout levels did not differ significantly between Hospital, Personalized Health Units and Families’ Health Centers. Professionals with more years in the function were less affected by Burnout (r = -0.15). No significant association was observed with the duration of the working day (r = 0.04). The strongest predictor of burnout was the perceived quality of working conditions (r = -0.35). Discussion: The occurrence of the burnout syndrome in Portuguese health professionals is frequent, being associated with a poor working conditions perception and reduced professional experience. The incidence of the burnout syndrome shows regional differences which may be associated with different and suboptimal conditions for health care delivery. Results suggest the need for interventions aimed at improving working conditions and initial job training of health professionals, as requisites for a good professional practice and personal well-being. Conclusions: At the national level, between 2011 and 2013, 21.6% of healthcare professionals showed moderate burnout and 47.8% showed high burnout. The perception of poor working conditions was the main predictor of burnout occurrence among the Portuguese health professionals.

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Transformation of primary care during the COVID-19 pandemic: experiences of healthcare professionals in eight European countries

British Journal of General Practice ◽

10.3399/bjgp.2020.1112 ◽

2021 ◽

pp. BJGP.2020.1112

Author(s):

Marta Wanat ◽

Melanie Hoste ◽

Nina Gobat ◽

Marilena Anastasaki ◽

Femke Boehmer ◽

...

Keyword(s):

Primary Care ◽

Secondary Care ◽

Healthcare Professionals ◽

Care Delivery ◽

Practical Training ◽

Structured Interviews ◽

New Ways Of Working ◽

Primary Care Delivery ◽

Local Primary Care ◽

Remote Care

Background: Primary care has a crucial role in responding to the COVID-19 pandemic as the first point of patient care and gatekeeper to secondary care. Qualitative studies exploring the experiences of healthcare professionals during the COVID-19 pandemic have mainly focused on secondary care. Aim: To understand the experiences of European PCPs working during the first peak of the COVID-19 pandemic. Design and Setting: An exploratory qualitative study, using semi-structured interviews in primary care in England, Belgium, the Netherlands, Ireland, Germany, Poland, Greece and Sweden, between April and July 2020. Method: Interviews were audio recorded, transcribed and analysed using a combination of inductive and deductive thematic analysis techniques. Results: Eighty interviews were conducted with PCPs. PCPs had to make their own decisions on how to rapidly transform services in relation to COVID-19 and non-COVID-19 care. Despite being overwhelmed with guidance, they often lacked access to practical training. Consequently, PCPs turned to their colleagues for moral support and information to try to quickly adjust to new ways of working, including remote care, and deal with uncertainty. Conclusion: PCPs rapidly transformed primary care delivery despite a number of challenges. Representation of primary care at policy level and engagement with local primary care champions will facilitate easy and coordinated access to practical information on how to adapt services, ongoing training and access to appropriate mental health support services for PCPs. Preservation of autonomy and responsiveness of primary care are critical to preserve the ability for rapid transformation in any future crisis of care delivery.

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Value-based genomic screening: exploring genomic screening for chronic diseases using triple value principles

BMC Health Services Research ◽

10.1186/s12913-019-4703-z ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Viktor Dombrádi ◽

Erica Pitini ◽

Carla G. van El ◽

Anant Jani ◽

Martina Cornel ◽

...

Keyword(s):

Chronic Diseases ◽

Healthcare Professionals ◽

Care Delivery ◽

Healthcare Resources ◽

Screening Criteria ◽

Policy Makers ◽

Personal Value ◽

Genomic Screening ◽

Wide Scale ◽

The Right

Abstract Background Genomic screening has unique challenges which makes it difficult to easily implement on a wide scale. If the costs, benefits and tradeoffs of investing in genomic screening are not evaluated properly, there is a risk of wasting finite healthcare resources and also causing avoidable harm. Main text If healthcare professionals – including policy makers, payers and providers – wish to incorporate genomic screening into healthcare while minimizing waste, maximizing benefits, and considering results that matter to patients, using the principles of triple value (allocative, technical, and personal value) could help them to evaluate tough decisions and tradeoffs. Allocative value focuses on the optimal distribution of limited healthcare resources to maximize the health benefits to the entire population while also accounting for all the costs of care delivery. Technical value ensures that for any given condition, the right intervention is chosen and delivered in the right way. Various methods (e.g. ACCE, HTA, and Wilson and Jungner screening criteria) exist that can help identify appropriate genomic applications. Personal value incorporates preference based informed decision making to ensure that patients are informed about the benefits and harms of the choices available to them and to ensure they make choices based on their values and preferences. Conclusions Using triple value principles can help healthcare professionals make reasoned and tough judgements about benefits and tradeoffs when they are exploring the role genomic screening for chronic diseases could play in improving the health of their patients and populations.

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