scholarly journals Process, quality and challenges of diabetes care in primary care: a study of district health network in Thailand

2020 ◽  
Vol 21 ◽  
Author(s):  
Jumnean Somanawat ◽  
Kritsanee Saramunee ◽  
Suratchada Chanasopon
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Quality Of Care ◽  
Health Care Providers ◽  
Diabetes Care ◽  
Care Process ◽  
Care Providers ◽  
District Health ◽  
Additional Support

Abstract This study aimed to describe the process of care, assess the quality of care based on defined indicators, and identify challenges associated with providing diabetes care via sub-district health promotion hospital (SHPH) facilities in Thailand. Primary care policy has directed that diabetes care be delivered via SHPH in order to reduce hospital congestion and minimize travel costs for patients. Limited data is available regarding the structure for providing care. Likewise, barriers to delivery of optimal care have not been well defined, especially from the perspective of health care providers. This study employed mixed-methods research, which included semi-structured interviews to gain insights into the current diabetes care process, a descriptive study to evaluate quality of care, and use of a focus group to identify challenges associated with delivery of diabetic care via SHPH. Diabetes care processes in primary care included multiple steps and involved collaboration between various health care providers at both the hospital and SHPH. Four process indicators and one outcome had been achieved but performance of other indicators was apparently low. Three factors were found to pose challenges to providing this service: the resources of the health service, the delivery of services, and patient factors. SHPH require additional support, particularly in the areas of primary care workforce, finance, medical device procurement, and patient information systems. While delivery of diabetes care via primary care centers has been well established in Thailand, regional differences in the quality of care persist. Additional support is required to strengthen the primary care system nationwide.

scholarly journals Patient Suffering in Chronic Digestive Diseases: Will Primary Care-Specialist Collaboration With Effective Interactive Communication and Integrative Medicine in the Plan of Care Improve Quality of Life?

2020 ◽  
Vol 7 (6) ◽  
pp. 989-993
Author(s):  
Andrew Thomas ◽  
Annie Thomas
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Health Care ◽  
Health Care Providers ◽  
The United States ◽  
Care Providers ◽  
Physician Visits ◽  
Digestive Diseases ◽  
Care Specialist

Acute and chronic digestive diseases are causing increased burden to patients and are increasing the United States health care spending. The purpose of this case report was to present how nonconfirmatory and conflicting diagnoses led to increased burden and suffering for a patient thus affecting quality of life. There were many physician visits and multiple tests performed on the patient. However, the primary care physician and specialists could not reach a confirmatory diagnosis. The treatment plans did not offer relief of symptoms, and the patient continues to experience digestive symptoms, enduring this burden for over 2 years. The central theme of this paper is to inform health care providers the importance of utilizing evidence-based primary care specialist collaboration models for better digestive disease outcomes. Consistent with patient’s experience, the authors propose to pilot/adopt the integrative health care approaches that are proven effective for treating digestive diseases.

scholarly journals Delirium and Antipsychotic Medications at Hospital Intake: Screening to Decrease Likelihood of Aggression in Inpatient Settings Among Unknown Patients With Dementia

2018 ◽  
Vol 34 (2) ◽  
pp. 118-123 ◽  
Author(s):  
Tracy Wharton ◽  
Daniel Paulson ◽  
Kimberly Burcher ◽  
Heather Lesch
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Quality Of Care ◽  
Health Care Providers ◽  
Antipsychotic Medication ◽  
Care Providers ◽  
Antipsychotic Medications ◽  
Inpatient Settings ◽  
Logistic Regressions

For individuals with dementia, disorientation and both external and internal stimuli may trigger behaviors that are difficult to manage or dangerous to health-care providers. Identification of correlational risk factors to aggressive behavior in patients who are unknown to the hospital can allow providers to adapt patient care quickly. Records for patients aged 60+ who spent at least 24 hours at the hospital other than in the psychiatric unit were used (N = 14 080). The first 4000 records and every 10th person who met criteria (N = 5008) were searched for documentation of dementia (n = 505). Logistic regressions and χ2 tests were used to examine relationships between variables. Recognition of delirium ( P = .014, Exp(B) = 2.53), coupled with an existing prescription for antipsychotic medication at intake ( P < .001, Exp(B) < 4.37), may be a reliable means of screening for risk and intervening at the earliest possible contact, improving quality of care and safety in acute care for individuals with dementia.

scholarly journals Birth Companions, Health workers perspective: Mixed Method Study in St. Paul’s Hospital and Millennium Medical College and its Catchment Centers in Addis Ababa, Ethiopia

2021 ◽  
Author(s):  
Kidist Gizachew ◽  
Tewodros Getinet ◽  
Delayehu Bekele
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Health Care Providers ◽  
Health Workers ◽  
Addis Ababa ◽  
Post Partum ◽  
Care Providers ◽  
Child Birth ◽  
Medical College

Abstract Background: Birth companions have been shown to improve quality of care provided to laboring women. Various studies have shown the benefits of companion during child birth. The objective of this study was to assess the knowledge, attitude and practice of health care providers towards the involvement of birth companions during child birth in St Paul’s Hospital Millennium Medical College (SPHMMC) and its selected catchment health centers. Methods: The study used a cross-sectional study which was supplemented by qualitative study design which employed phenomenological design was conducted using in depth interview of health care providers who were on practice during the study period in SPHMMC. Result: The study included a total 58 health care providers. The finding from the study showed that great proportion of health care providers involved in the study (90 %) have positive attitude towards involvement of birth companions but majority 82.4 % didn’t allow birth companions. The commonest reasons mentioned for not involving companions include fear of breach of privacy, interference with routine medical care and risk of litigation/complaints.Conclusion and Recommendation: The findings from this study showed that majority of the health care providers are against the practice of involving birth companions. Since involvement of birth companions is one way to ensure the quality of care provided there should be an effort to increase the knowledge of health professionals on benefits of birth companions. There is also a need for improvement of the work setup. Simple measures like providing screens, providing separate rooms for laboring and post-partum women will have a significant impact on the quality of care provided.

scholarly journals Online public reactions to frequency of diagnostic errors in US outpatient care

Diagnosis ◽  
2016 ◽  
Vol 3 (1) ◽  
pp. 17-22 ◽  
Author(s):  
Traber Davis Giardina ◽  
Urmimala Sarkar ◽  
Gato Gourley ◽  
Varsha Modi ◽  
Ashley N.D. Meyer ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Health Care Providers ◽  
Diagnostic Errors ◽  
News Article ◽  
Care Providers ◽  
Qualitative Researcher ◽  
Related Quality ◽  
The Impact

AbstractDiagnostic errors pose a significant threat to patient safety but little is known about public perceptions of diagnostic errors. A study published inWe searched the World Wide Web for any news article reporting findings from the study. We then gathered all the online comments made in response to the news articles to evaluate public reaction to the newly reported diagnostic error frequency (n=241). Two coders conducted content analyses of the comments and an experienced qualitative researcher resolved differences.Overall, there were few comments made regarding the frequency of diagnostic errors. However, in response to the media coverage, 44 commenters shared personal experiences of diagnostic errors. Additionally, commentary centered on diagnosis-related quality of care as affected by two emergent categories: (1) US health care providers (n=79; 63 commenters) and (2) US health care reform-related policies, most commonly the Affordable Care Act (ACA) and insurance/reimbursement issues (n=62; 47 commenters).The public appears to have substantial concerns about the impact of the ACA and other reform initiatives on the diagnosis-related quality of care. However, policy discussions on diagnostic errors are largely absent from the current national conversation on improving quality and safety. Because outpatient diagnostic errors have emerged as a major safety concern, researchers and policymakers should consider evaluating the effects of policy and practice changes on diagnostic accuracy.

scholarly journals Standards and outcome measures in Cardiovascular Rehabilitation. Position Paper GICR/IACPR

2015 ◽  
Vol 78 (4) ◽  
Author(s):  
Raffaele Griffo ◽  
Marco Ambrosetti ◽  
Giuseppe Furgi ◽  
Roberto Carlon ◽  
Carmine Chieffo ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Cardiovascular Diseases ◽  
Health Care Providers ◽  
Professional Competence ◽  
Care Delivery ◽  
Position Paper ◽  
Care Providers ◽  
Cardiac Events

Despite major improvements in diagnostics and interventional therapies, cardiovascular diseases remain a major health care and socio-economic problem in Italy. Costs and resources required are increasing in close correlation to both the improved quality of care and to the population ageing. There is an overwhelming evidence of the efficacy of cardiac rehabilitation (CR) in terms of reduction in morbidity and mortality after acute cardiac events. CR services are by definition multi-factorial and comprehensive. Furthermore, systematic analysis and monitoring of the process of delivery and outcomes is of paramount importance. The aim of this position paper promoted by the Italian Association for Cardiovascular Prevention and Rehabilitation (GICR-IACPR) is to provide specific recommendations to assist CR staff in the design, evaluation and development of their care delivery organization. The position paper should also assist health care providers, insurers, policy makers and consumers in the recognition of the quality of care requirements, standards and outcome measure, quality and performance indicators, and professional competence involved in such organization and programs. The position paper i) include comprehensive CR definition and indications, ii) describes priority criteria based on the clinical risk for admission to both inpatient or outpatient CR, and iii) defines components and technological, structural and organizing requirements for inpatient or outpatient CR services, with specific indicators and standards, performance measures and required professional skills. A specific chapter is dedicated to the requirements for highly specialized CR services for patients with more advanced cardiovascular diseases.

scholarly journals Impact evaluation of the Steno REACH Certificate Course in Clinical Diabetes Care for health care providers in Malaysia: protocol for a quasi-experimental, mixed-methods research study

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 98 ◽  
Author(s):  
Feisul Mustapha ◽  
Michael Calopietro ◽  
Karoline Kragelund Nielsen ◽  
Jens Aagaard-Hansen ◽  
Shiang Cheng Lim ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Providers ◽  
Diabetes Care ◽  
Clinical Diabetes ◽  
Care Providers ◽  
Health Clinics ◽  
Quasi Experimental ◽  
E Learning

The burden of diabetes continues to increase in Malaysia, and the public primary health sector has an insufficient number of health care providers well-trained in diabetes care. The Ministry of Health Malaysia collaborated with Steno Diabetes Center to educate primary care doctors and nurses on the fundamentals of clinical diabetes care using a competency-based approach that blends e-learning, classroom-based learning, and clinic-based group work. This programme is called Steno REACH Certificate Course in Clinical Diabetes Care (SRCC). The aim of this study was to assess the effectiveness of the SRCC intervention in improving diabetes-related knowledge, attitudes, skills and clinical practices among non-specialised doctors and general nurses working in public health clinics in Malaysia. This paper presents the study protocol. A quasi-experimental, mixed-methods study based on Solomon’s Four Group Design was applied. Non-specialist doctors and general nurses from ten health clinics were randomly selected to receive the educational intervention. Comparison clinics were purposive selected matching on proxy indicators for quality of diabetes care. The intervention consisted of 50 hours of e-learning, 48 hours of classroom-based learning and approximately 25 hours of work-based learning that covered all main aspects of clinical diabetes care and delivered over a six-month period. Primary outcomes were changes in diabetes-related knowledge, attitudes, skills, and clinical practice. Patients’ perceptions regarding the quality of care provided were classified as a secondary outcome. Other outcome measures included patients' assessment of their chronic disease care and providers' perceptions, attitudes and perceived barriers in care delivery. Results from this study will inform future educational approaches within the Malaysian health system. The study is unique because it evaluated a pertinent public health topic using a very robust methodology.

A Social-Ecological Approach to Determine Barriers of DMSM Practice For Patients with Type 2 Diabetes Mellitus: A literature review

2018 ◽  
Vol 1 (1) ◽  
pp. 1-20
Author(s):  
Andi Mayasari Usman ◽  
Rian Adi Pamungkas
Keyword(s):  
Diabetes Mellitus ◽  
Health Care ◽  
Health Care Provider ◽  
Health Care Providers ◽  
Care Provider ◽  
Diabetes Care ◽  
Diabetes Management ◽  
Self Management ◽  
Care Providers

Diabetes mellitus is one of the global problems the world. Since the complexity of the patient’s tasks is required in the diabetes care, the consistency to engage this various health behavior for addressing the glycemic control target is difficult to achieve. Failure management may reflect by patient, family, inadequate intervention strategies by health care provider as well as organization factor. Three databases used such as PubMed, MIDLINE, and CINAHL to address patient’s barriers, family’s barriers, and provider’s barriers as well as organization barriers for diabetes management. Patient’s attitudes and belief, knowledge, culture, and ethnicity, self-efficacy, financial resources and economic status, lack of Social Support Perceived, and lack of time may influence the diabetes self-management. Family factors lead to patients’ diabetes self-management such as lack of knowledge and skill to support patients in diabetes management and quality of the relationship between patients-family. Health care providers factors included beliefs, attitudes, knowledge and skill and patient–family-provider interaction and communication. Other factors lead to diabetes self-management and health care provider performance to provide the intervention from organization level such as integrated health system sufficiency health insurance to support resources. A deeper understanding of the barriers in diabetes management is necessary to improve the diabetes care and quality of health care services for patients with diabetes. Further research needs to consider these barriers before designing the effective, sensitive interventions and problem solving for diabetes care

scholarly journals Quality and barriers of outpatient diabetes care in rural health facilities in Uganda – a mixed methods study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Catherine Birabwa ◽  
Mulekya F. Bwambale ◽  
Peter Waiswa ◽  
Roy W. Mayega
Keyword(s):  
Blood Pressure ◽  
Quality Of Care ◽  
Mixed Methods ◽  
Blood Glucose ◽  
Health Outcomes ◽  
Diabetes Care ◽  
Blood Cholesterol ◽  
Care Process ◽  
Care Providers

Abstract Background Despite the increasing burden of diabetes in Uganda, little is known about the quality of type 2 diabetes mellitus (T2DM) care especially in rural areas. Poor quality of care is a serious limitation to the control of diabetes and its complications. This study assessed the quality of care and barriers to service delivery in two rural districts in Eastern Uganda. Methods This was a mixed methods cross-sectional study, conducted in six facilities. A randomly selected sample of 377 people with diabetes was interviewed using a pre-tested interviewer administered questionnaire. Key informant interviews were also conducted with diabetes care providers. Data was collected on health outcomes, processes of care and foundations for high quality health systems. The study included three health outcomes, six elements of competent care under processes and 16 elements of tools/resources and workforce under foundations. Descriptive statistics were computed to determine performance under each domain, and thematic content analysis was used for qualitative data. Results The mean age of participants was 49 years (±11.7 years) with a median duration of diabetes of 4 years (inter-quartile range = 2.7 years). The overall facility readiness score was 73.9%. Inadequacies were found in health worker training in standard diabetes care, availability of medicines, and management systems for services. These were also the key barriers to provision and access to care in addition to lack of affordability. Screening of clients for blood cholesterol and microvascular complications was very low. Regarding outcomes; 56.8% of participants had controlled blood glucose, 49.3% had controlled blood pressure; and 84.0% reported having at least one complication. Conclusion The quality of T2DM care provided in these rural facilities is sub-optimal, especially the process of care. The consequences include sub-optimal blood glucose and blood pressure control. Improving availability of essential medicines and basic technologies and competence of health workers can improve the care process leading to better outcomes.

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