Le désintérêt progressif des résidents en médecine familiale à l’égard du suivi à domicile des personnes âgées

2014 ◽  
Vol 33 (2) ◽  
pp. 176-184
Author(s):  
François Aubry ◽  
Yves Couturier ◽  
Serge Dumont
Keyword(s):  
Family Medicine ◽  
The Elderly ◽  
Patient Centered ◽  
Medical Interventions ◽  
Short Period ◽  
Before And After ◽  
Centered Care ◽  
Administrative Tasks ◽  
Family Medicine Residents

ABSTRACTThis paper deals with the lack of interest shown by family medicine residents in Quebec (Canada) in home follow-up or monitoring of the elderly. By collecting and analyzing data from sixteen family medicine residents before and after their first experience of home follow-up, and from four medical supervisors, we found that residents experience a rapid loss of interest in this practice over a very short period. We show that this lack of interest stems first from the difficulty of applying the principle of patient-centered care, wherein medical interventions must meet the needs of the elderly in their entirety. Secondly, residents complain that they have to deal with many administrative tasks. They call for implementation of professional features to better integrate services such as case management.

scholarly journals Comprehensive Obesity Education for Family Medicine Residents

PRiMER ◽  
2020 ◽  
Vol 4 ◽  
Author(s):  
Birgit Khandalavala ◽  
Jessica Koran-Scholl ◽  
Jenenne Geske
Keyword(s):  
Family Medicine ◽  
Implicit Bias ◽  
Primary Care Providers ◽  
Mitigation Strategies ◽  
Care Providers ◽  
Patient Centered ◽  
Obesity Bias ◽  
Health Expert ◽  
Centered Care ◽  
Family Medicine Residents

Background: Family medicine residents receive limited education on obesity management and obesity bias. Weight stigmatization is prevalent in primary care providers and trainees, and early mitigation is critical to optimize patient-centered care. Recent Provider Competencies for the Prevention and Management of Obesity include obesity bias. This report is intended to fill a current gap in obesity education for family medicine residents. Methods: An interprofessional obesity teaching half day for family medicine residents incorporated the Provider Competencies and focused on five modules that addressed complexities of obesity and its clinical management. The obesity bias module focused on both explicit and implicit bias, assessment of implicit bias, preferential language usage, and mitigation strategies. An obesity-simulation empathy suit was available, and a public health expert described successful obesity care in a patient-centered medical home. Family medicine residents were surveyed prior to, immediately after the half-day of obesity teaching, and 15 months later. Results: Survey results indicated 39.3% of residents had no previous biopsychosocial obesity education. Residents believed the content moderately (68.8%) or mostly (12.5%) impacted their approach to working with patients with obesity. Residents’ comfort in working with patients with obesity as well as their perceived understanding of their own biases increased immediately after the intervention and was sustained 15 months later. Conclusions: Our results suggest that a half day of obesity teaching can have a positive and sustained impact on family medicine residents. Additionally, this educational experience allowed for greater individual awareness building and insight regarding implicit bias. Such education for family medicine residents fills an identified gap in obesity education.

Forensic Issues and Caregivers of the Elderly

2017 ◽  
Author(s):  
Gary Epstein-Lubow ◽  
Elizabeth Tobin-Tyler
Keyword(s):  
Mental Health ◽  
Family Caregivers ◽  
Mental Health Treatment ◽  
Ethical Issues ◽  
The Elderly ◽  
Patient Centered Care ◽  
Health Condition ◽  
Patient Centered ◽  
Centered Care ◽  
Laws And Policies

Providing patient-centered care for an elderly individual with a mental health condition requires clinicians and family caregivers to work together. This chapter provides a description of a mental health treatment model, the triadic model of caregiving, in which service delivery for a patient includes clinicians communicating with family members or caregivers. Description of the mental health workforce to support patient-centered care is provided along with laws and policies that support family caregivers in their aid of patients. The associated legal responsibilities and ethical issues related to working with patients who have impaired decision-making capacity due to a mental health or substance use condition are explained, including capacity, competence, informed consent, advance care planning, guardianship, fiduciary responsibilities, and ethical concerns.

scholarly journals Facilitators and Barriers to Implementing a Patient-Centered Oncology Care Model

2020 ◽  
Vol 16 (12) ◽  
pp. e1441-e1450
Author(s):  
Manasi A. Tirodkar ◽  
Lindsey Roth ◽  
Shelley Fuld Nasso ◽  
Mark W. Friedberg ◽  
Sarah H. Scholle
Keyword(s):  
Care Coordination ◽  
Medical Home ◽  
Financial Incentives ◽  
Technical Assistance ◽  
Patient Centered Care ◽  
Self Report ◽  
Patient Centered ◽  
Leadership Support ◽  
Centered Care

PURPOSE: Oncology practices often serve as the “medical home” for patients but may not have systems to support all aspects of patient-centered care. We piloted a new set of oncology medical home standards that call for accessible, continuous, coordinated, and team-based care. We examined how adoption of the standards varies across a variety of practices and compared practice self-report with external evaluation of implementation. METHODS: Five medical oncology practices in southeastern Pennsylvania implemented the standards from 2014 into 2016. Implementation support included training webinars and technical assistance. External reviewers evaluated practices’ implementation of the standards. We conducted site visits to interview providers and patients. RESULTS: Between baseline and follow-up, practice self-assessments and independent audits showed practices increased implementation of the patient-centered oncology standards. The largest improvement was seen in continuous quality improvement (QI). Practices were less successful in implementing care coordination: achievement on two standards (access and evidence-based decision support) declined from baseline to follow-up. Qualitative analyses revealed that practices focused QI in five areas: goals of care, engaging patients in QI, financial counseling, symptom management, and care coordination. Interviewees talked about facilitators, such as leadership support and physician buy-in, and barriers to transformation, including inadequate resources and staffing. Health information technology both supported and limited implementation. CONCLUSION: Oncology practices showed some progress in their implementation of patient-centered care processes over the course of the pilot program. Systems for tracking and documenting improvement, training for staff and clinicians, leadership support, and alignment of financial incentives are critical to transformation.

scholarly journals The paediatric developmental toolkit: Facilitating learning of child development

2020 ◽  
Author(s):  
Elizabeth Young ◽  
Thivia Jegathesan ◽  
Hyeji Park ◽  
Mohammad Samad Zubairi
Keyword(s):  
Child Development ◽  
Family Medicine ◽  
Developmental Disorders ◽  
Primary Objective ◽  
Children And Youth ◽  
Clinical Settings ◽  
Clinical Teachers ◽  
Clinical Encounters ◽  
Short Period ◽  
Family Medicine Residents

Abstract Background Recent paediatric and family medicine graduates report feeling unprepared to identify and address children and youth with developmental disorders. Developmental history taking and physical examination alone limit engagement with children and youth in an interactive manner to assess development. The paediatric developmental toolkit (PDT) was developed to provide trainees with the opportunity to interact with a child in a play-based manner. Objectives The primary objective of this study was to determine the feasibility of PDT within clinical settings, and qualitatively explore how the PDT can be used by teachers and trainees. Methods Trainees and their clinical teachers participated in a qualitative study. Trainees used the PDT in clinical settings and were interviewed following their clinical encounters. Interactions between clinical teachers and trainees following the use of the PDT were also recorded. Teachers were interviewed following the trainees’ case presentations and closures of clinic visits. Trainee interviews, teacher and trainee interactions, and teacher interviews were audiotaped, transcribed, and analyzed thematically. Results Nine trainees (six paediatric residents, two family medicine residents, and one clinical clerk medical student) and four developmental paediatricians participated in the study. Each trainee used the PDT twice in two different clinical encounters. All residents agreed the PDT enabled them to observe a child’s developmental skills in a short period of time. Clinical teachers all felt the toolkit allowed trainees to more holistically consider a child’s development and diagnosis. Conclusions As medical education shifts to a competency-based education curriculum, the PDT is an innovative tool that can be used to enhance paediatric and family medicine residents’ learning of child development by enabling opportunities for interaction with children.

Optimizing patient education of oncology medications: A quantitative analysis of the patient perspective

2019 ◽  
Vol 25 (6) ◽  
pp. 1445-1455
Author(s):  
Kristin Kaupp ◽  
Samantha Scott ◽  
Laura V Minard ◽  
Tessa Lambourne
Keyword(s):  
Nova Scotia ◽  
Patient Education ◽  
Formal Education ◽  
Hospital Pharmacist ◽  
Patient Centered ◽  
Cancer Treatments ◽  
Post Secondary ◽  
Centered Care ◽  
Descriptive Survey

Background With the ever-increasing complexity of cancer treatments, oncology medication patient education is becoming a progressively important component of cancer care. Despite this, cancer patients frequently report that they receive inadequate information and feel that their education needs have not been met. Objective To explore patients' perspectives of optimal oncology medication education across Nova Scotia. Methods This was a descriptive survey of adult medical, hematological and gynaecological oncology outpatients receiving intravenous chemotherapy within the Nova Scotia Health Authority between January 26 and April 30, 2018. Results One hundred forty-two responses were included; 41% and 47% of respondents reported being satisfied or very satisfied with their oncology medication education, respectively; 30% and 43% of respondents would like the opportunity to receive education or follow-up from a hospital pharmacist, respectively. Respondents with post-secondary education were found to have 2.82 higher odds of wanting to make an appointment for education with a hospital pharmacist. Conclusions Patients were generally satisfied with their oncology medication education despite the majority not receiving education from a hospital pharmacist. Patients with a higher level of formal education were more likely to want the opportunity to schedule an appointment for education with and/or receive follow-up from a hospital pharmacist. The oncology medication education participants received in the past appeared to align with their education preferences. Findings from this research can be used to optimize the limited time healthcare professionals have to provide meaningful and effective oncology medication patient education and improve patient-centered care.

scholarly journals Neurological and functional outcomes of subdural hematoma evacuation in patients over 70 years of age

2013 ◽  
Vol 04 (03) ◽  
pp. 250-256 ◽  
Author(s):  
Patrick Mulligan ◽  
Bethwel Raore ◽  
Shuling Liu ◽  
Jeffrey J Olson
Keyword(s):  
Functional Status ◽  
Subdural Hematoma ◽  
Functional Outcomes ◽  
The Elderly ◽  
Neurological Status ◽  
Common Disease ◽  
Before And After ◽  
Grading Scale ◽  
Burr Holes

ABSTRACT Background: Subdural hematoma (SDH) is a common disease entity treated by neurosurgical intervention. Although the incidence increases in the elderly population, there is a paucity of studies examining their surgical outcomes. Objectives: To determine the neurological and functional outcomes of patients over 70 years of age undergoing surgical decompression for subdural hematoma. Materials and Methods: We retrospectively reviewed data on 45 patients above 70 years who underwent craniotomy or burr holes for acute, chronic or mixed subdural hematomas. We analyzed both neurological and functional status before and after surgery. Results: Forty-five patients 70 years of age or older were treated in our department during the study period. There was a significant improvement in the neurological status of patients from admission to follow up as assessed using the Markwalder grading scale (1.98 vs. 1.39; P =0.005), yet no improvement in functional outcome was observed as assessed by Glasgow Outcome Score. Forty-one patients were admitted from home, however only 20 patients (44%) were discharged home, 16 (36%) discharged to nursing home or rehab, 6 (13%) to hospice and 3 (7%) died in the postoperative period. Neurological function improved in patients who were older, had a worse pre-operative neurological status, were on anticoagulation and had chronic or mixed acute and chronic hematoma. However, no improvement in functional status was observed. Conclusion: Surgical management of SDH in patients over 70 years of age provides significant improvement in neurological status, but does not change functional status.

scholarly journals Formação de cuidadores de idosos institucionalizados

2019 ◽  
Vol 13 (5) ◽  
pp. 1216
Author(s):  
Vitor Emanuel Sousa da Silva ◽  
Kaiza Vilarinho da Luz ◽  
Dalton Kaynnan de Prado Costa ◽  
André Ricardo Ferreira da Silva Rocha ◽  
Rosângela Nunes Almeida ◽  
...  
Keyword(s):  
The Elderly ◽  
Cross Sectional Study ◽  
Health Care Education ◽  
Patient Centered ◽  
Cross Sectional ◽  
Calidad De Vida ◽  
Caregiver Quality ◽  
Centered Care ◽  
Qualitative Descriptive ◽  
Elderly Caregivers

RESUMOObjetivo: analisar a formação dos cuidadores de idosos institucionalizados. Método: trata-se de um estudo qualitativo, descritivo e transversal. Realizou-se com dez cuidadores de instituição de longa permanência (ILP), utilizando-se um instrumento semiestruturado. Submeteram-se os dados coletados à Análise de Discurso. Resultados: registra-se que predominaram as cuidadoras do gênero feminino, casadas, com idade média de 42 anos, e que o período médio de atuação na área foi de 7,1 anos. Sabe-se que 90% tinham formação em cuidador de idoso e elencaram, como dificuldades, colocar a fralda, dar banho, a comunicação e as estratégias para interagir com a teimosia dos idosos, bem como as demandas dos idosos e a sobrecarga de peso e de trabalho. Conclusão: concluiu-se que há a necessidade de se qualificar bem e atualizar a formação do cuidador profissional para que este possa executar a sua práxis com segurança, efetividade, eficiência e atenção centrada no paciente. Descritores: Saúde do Idoso; Cuidador; Qualidade de Vida; Atenção Primária à Saúde; Educação; Ensino.ABSTRACT Objective: to analyze the training of institutionalized elderly caregivers. Method: this is a qualitative, descriptive and cross-sectional study. It was carried out with ten caregivers of long-term institution (LTI), using a semi-structured instrument. The collected data were submitted to Speech Analysis. Results: it is recorded that the female carers, married, with a mean age of 42 years, predominated, and that the average period of performance in the area was 7.1 years. It is known that 90% had training in elderly caregivers and listed, as difficulties, putting diapers, bathing, communication and strategies to interact with the stubbornness of the elderly, as well as the demands of the elderly and the overload of weight and of work. Conclusion: it was concluded that there is a need to qualify well and update the training of the professional caregiver so that they can perform their praxis with safety, effectiveness, efficiency and patient-centered care. Descriptors: Elderly Health; Caregiver; Quality of life; Primary Health Care; Education; Teaching.RESUMEN Objetivo: analizar la formación de los cuidadores de ancianos institucionalizados. Método: se trata de un estudio cualitativo, descriptivo y transversal. Se realizó con diez cuidadores de institución de larga permanencia (ILP), utilizando un instrumento semiestructurado. Se sometieron los datos recogidos al Análisis de Discurso. Resultados: se registra que predominaron las cuidadoras del género femenino, casadas, con edad promedio de 42 años, y que el período promedio de actuación en el área fue de 7,1 años. Se sabe que el 90% tenía formación en cuidador de anciano y enumeró, como dificultades, colocar el pañal, bañar, la comunicación y las estrategias para interactuar con la terquedad de los ancianos, así como las demandas de los ancianos y la sobrecarga de peso y de trabajo. Conclusión: se concluyó que hay la necesidad de calificar bien y actualizar la formación del cuidador profesional para que éste pueda ejecutar su praxis con seguridad, efectividad, eficiencia y atención centrada en el paciente. Descritores: Salud del Anciano; Cuidadores; Calidad de Vida; Atención Primaria de Salud; Educación; Enseñanza.

scholarly journals Utilizing Practice-Based Research Networks to Teach and Implement Quality Improvement in Academic Medicine

2020 ◽  
Vol 52 (9) ◽  
pp. 642-646
Author(s):  
Clarissa Hoff ◽  
Luisito Caleon ◽  
Grace Lee ◽  
Mathew Quan
Keyword(s):  
Quality Improvement ◽  
Family Medicine ◽  
Leadership Skills ◽  
Research Network ◽  
Improvement Project ◽  
Residency Programs ◽  
Before And After ◽  
Practice Based Research ◽  
Attending Physicians ◽  
Family Medicine Residents

Background and Objectives: A 2019 study found that between 2014 and 2017, family medicine residents had little improvement in self-assessed preparedness to lead quality improvement projects. This study explored the effectiveness of leveraging a practice-based research network (PBRN) across multiple family medicine residencies not only for implementing quality improvement projects, but also as a teaching tool designed to improve knowledge, attitudes, beliefs, and leadership skills in family medicine faculty and residents. Methods: Residents in family medicine residency programs and one community internal medicine program and family medicine teaching faculty participated in a PBRN-led quality improvement project (QIP) to improve colon cancer screening in their clinic. Of 101 participants, 79 (78%) were residents and 22 (22%) were faculty or attending physicians. Questions surveying participants’ knowledge and confidence related to QIP before and after the QIP were given. Results: Overall, participants reported an improvement in their basic understanding of QI concepts (P=.004). They also reported having sufficient staff and ancillary support to meaningfully participate (P=.033). Participants indicated they had more confidence in their ability to participate in a QI project (P=.002), initiate, design, and lead such a project (P=.001), and teach their peers and staff basic QI concepts (P<.001). Conclusions: PBRNs appear to be a unique way to subjectively improve residents’ confidence in their quality improvement skills. PBRNs should be further explored as a method for educating family medicine residents in quality improvement.

Patient-reported outcomes for performance measurement: Multi-institution challenges.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 211-211
Author(s):  
Constance Barysauskas ◽  
Kristen K. McNiff ◽  
Stephen Flaherty ◽  
Mary Ellen Morba ◽  
Tracy E. Spinks ◽  
...  
Keyword(s):  
Performance Measurement ◽  
Patient Reported Outcomes ◽  
Quality Of Healthcare ◽  
Patient Centered ◽  
Aggregated Data ◽  
Cancer Centers ◽  
Care Experience ◽  
Patient Reported ◽  
Before And After ◽  
Centered Care

211 Background: Patient-reported outcomes (PROs) are self-reported measures of a patient’s health or healthcare experience. PRO utilization is driven by the movement toward patient-centered care and emerging evidence which suggests patients (pts) more involved in their care experience better outcomes. The infrastructure to capture PROs is evolving and PROs are now used for performance measurement (PM). PRO-PMs assess the quality of healthcare for improvement and/or accountability; but implementation is challenging. Success of PRO-PM requires identification of pts, ongoing data collection and data aggregation across institutions. The Alliance of Dedicated Cancer Centers (ADCC) identified challenges of PRO use for PM. Methods: The validated tool, Expanded Prostate Cancer Index Composite, evaluating pt function and bother from treatment (trt), administered to new localized prostate pts at three independent cancer centers was retrospectively collected. Surveys administered before and after trt measured change from trt. Results: Institutions implementing PROs following local standards resulted in a high degree of variation. The aggregated data presented challenges in identifying eligible pt populations who received surveys before and after trt within a timeframe. We identified a pragmatic and meaningful pt population and survey implementation window. Pts were stratified by center and trt modality for analysis. Conclusions: The aggregation of dissimilar data sources led to the identification of institution implementation and data capture differences, however, the ADCC identified variation for PRO measure development. Clear guidance, policies and procedures are essential to ensure adequate homogeneity and reduced variability, to assure meaningful PM and reduce confounding by institution. [Table: see text]

scholarly journals Incorporating the Principles of Self-Management into Treatment of Dysarthria Associated with Parkinson's Disease

2017 ◽  
Vol 38 (03) ◽  
pp. 210-219 ◽  
Author(s):  
Carolyn Baylor ◽  
Deanna Britton ◽  
Kathryn Yorkston
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Current Treatment ◽  
Patient Perspectives ◽  
Self Management ◽  
Patient Centered ◽  
Treatment Expectations ◽  
Before And After ◽  
Centered Care ◽  
Speech Loudness

AbstractAlthough understanding patient perspectives on treatment is a major component of patient-centered care, little is known about patient perspectives related to dysarthria treatment in Parkinson's disease (PD). This article attempts to explore the perspective of patients with dysarthria associated with PD by interviewing them before and after treatment. Treatment expectations and experiences are summarized along with a discussion of how patients are using the tools they learned once treatment was completed. Comments about treatment were generally positive and suggested increased awareness and improved speech loudness. However, areas for improvement were also identified including: (1) treatment was not addressing some communication problems that were of concern to patients; (2) therapy programs were not enjoyable; and (3) it was difficult to maintain gains after therapy ended. Principles of self-management are reviewed to address some of the shortcomings of current treatment approaches.

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