Addressing chronic and complex conditions: what evidence is there regarding the role primary healthcare nurses can play?

2013 ◽  
Vol 37 (5) ◽  
pp. 588 ◽  
Author(s):  
Anne M. Parkinson ◽  
Rhian Parker
Keyword(s):  
Chronic Disease ◽  
Primary Healthcare ◽  
Cost Effective ◽  
Healthcare Services ◽  
Scope Of Practice ◽  
Ageing Population ◽  
International Evidence ◽  
Effective Care ◽  
Rural And Remote Areas ◽  
Healthcare Interventions

Primary healthcare services in Australia need to respond to the needs of an ageing population and the rising prevalence of chronic and complex conditions in that population. This paper reports on the results of a comprehensive Australian and international literature review on nurse-led and nurse-involved primary healthcare interventions with a particular focus on those serving people with chronic and complex conditions and hard to reach populations. The key question this review addresses is: what role can nurses play in primary healthcare to manage people with chronic and complex conditions? International evidence demonstrates that nurses working in primary care provide effective care, have high patient satisfaction and patients are more likely to comply with nurse instructions than general practitioner instructions. Nurses can provide care equivalent to doctors within their scope of practice but have longer consultations. Lifestyle interventions provided by nurses have been shown to be effective for cardiac care, diabetes care, smoking cessation and obesity. The nursing workforce can provide appropriate, cost-effective and high-quality primary healthcare within their scope of practice. What is known about the topic? The prevalence of chronic disease worldwide is increasing due to our lifestyles and ageing populations combined with our extended lifespans. People living in rural and remote areas have higher rates of disease and injury, and poorer access to healthcare. In particular, many older people suffer multiple chronic and complex conditions that require significant clinical management. Nurses are playing increasingly important roles in the delivery of primary healthcare worldwide and international evidence demonstrates that nurses can provide equivalent care to doctors within their scope of practice but have longer consultations. What does this paper add? There is clear international evidence that nurses can play a more significant role in supporting preventive activities and addressing the needs of an ageing population with chronic and complex conditions. In contrast with earlier evidence, recent evidence suggests that nurses may provide the most cost-effective care. What are the implications for practitioners? Adequately prepared nurses can provide a range of effective and cost-effective primary healthcare services in chronic disease management. Studies report that patients are satisfied with nursing care. Nurses should be utilised to their full scope of practice to provide ongoing care to these populations.

scholarly journals Introduction to the development of complex interventions

2021 ◽  
pp. postgradmedj-2021-139766
Author(s):  
Sarah Brewster ◽  
Richard Holt ◽  
Hermione Price
Keyword(s):  
Medical Research ◽  
Research Council ◽  
Medical Research Council ◽  
Complex Interventions ◽  
Cost Effective ◽  
Intervention Design ◽  
Iterative Approach ◽  
Careful Attention ◽  
Effective Care ◽  
Healthcare Interventions

Healthcare interventions are complex, but have the potential to deliver more efficient, cost-effective care and improved health outcomes. Careful attention must be paid to their early planning and development to minimise research waste or interventions that fail to deliver what they set out to achieve. The Medical Research Council provides guidance to help intervention developers, encouraging an explicit and iterative approach. This article describes the Medical Research Council’s guidance and introduces two frequently used tools that further support the process of intervention design.

Perspectives of rural and remote primary healthcare services on the meaning and goals of clinical governance

2017 ◽  
Vol 23 (5) ◽  
pp. 451 ◽  
Author(s):  
Ruyamuro K. Kwedza ◽  
Sarah Larkins ◽  
Julie K. Johnson ◽  
Nicholas Zwar
Keyword(s):  
Primary Healthcare ◽  
Participant Observation ◽  
Health Centre ◽  
Document Analysis ◽  
Healthcare Services ◽  
Clinical Governance ◽  
Rural And Remote ◽  
Structured Interviews ◽  
Frontline Staff ◽  
Rural And Remote Areas

Definitions of clinical governance are varied and there is no one agreed model. This paper explored the perspectives of rural and remote primary healthcare services, located in North Queensland, Australia, on the meaning and goals of clinical governance. The study followed an embedded multiple case study design with semi-structured interviews, document analysis and non-participant observation. Participants included clinicians, non-clinical support staff, managers and executives. Similarities and differences in the understanding of clinical governance between health centre and committee case studies were evident. Almost one-third of participants were unfamiliar with the term or were unsure of its meaning; alongside limited documentation of a definition. Although most cases linked the concept of clinical governance to key terms, many lacked a comprehensive understanding. Similarities between cases included viewing clinical governance as a management and administrative function. Differences included committee members’ alignment of clinical governance with corporate governance and frontline staff associating clinical governance with staff safety. Document analysis offered further insight into these perspectives. Clinical governance is well-documented as an expected organisational requirement, including in rural and remote areas where geographic, workforce and demographic factors pose additional challenges to quality and safety. However, in reality, it is not clearly, similarly or comprehensively understood by all participants.

The Pharmacist's Role in Developing Diabetes Clinical Care Pathways and Diabetes Patient-Focused Care Plans

1997 ◽  
Vol 10 (6) ◽  
pp. 374-378
Author(s):  
Jodie J. Cardenas
Keyword(s):  
Clinical Practice ◽  
Chronic Disease ◽  
Clinical Care ◽  
Cost Effective ◽  
Healthcare Services ◽  
Diabetes Patient ◽  
Care Pathways ◽  
Management Tools ◽  
Healthcare Market ◽  
Care Plans

Diabetes is a serious, chronic disease affecting an estimated 16 million Americans with total costs in excess of $92 billion a year. A changing healthcare market is creating demand for coordinated, standardized methods of optimizing both outcomes and resource utilization. Diabetes clinical care pathways (DCCPs) and diabetes patient-focused care plans (DPFCPs) are valuable management tools used to coordinate the delivery of clinically appropriate, cost-effective, interdisciplinary diabetes healthcare services. This article identifies the characteristics of DCCPs and DPFCPs, and describes the pharmacist's role in their development and use in clinical practice.

scholarly journals The Knowledge and Behaviours of the Healthcare Staff Regarding Vaccine Rejection

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Gokce ◽  
A T Ozdemir ◽  
G Boz ◽  
M Aslan ◽  
A Ozer
Keyword(s):  
Primary Healthcare ◽  
Cost Effective ◽  
Healthcare Services ◽  
City Centre ◽  
The Internet ◽  
Healthcare Staff ◽  
Cross Sectional ◽  
Significance Level ◽  
Primary Body ◽  
Source Of Information

Abstract Background Vaccination is a cost-effective method to protect individuals from diseases and complications that might emerge due to diseases. The healthcare staff in primary healthcare services, as the primary body concerned with vaccines, are notably more likely to encounter families who reject vaccines in childhood. This study aimed to investigate the knowledge, attitudes and behaviours of the healthcare staff in primary healthcare services regarding vaccine rejection in childhood. Methods Conducted between July and August 2019, this study adopted a descriptive cross-sectional design. The population of the study comprised 392 healthcare staff working in primary healthcare services in Malatya City Centre. The sample size was calculated as 193, considering a 95% confidence interval and 80% power. The survey form used in the study included questions concerning sociodemographic characteristics of individuals, their views on vaccination and the views of parents regarding vaccine rejection according to the perspectives of the healthcare staff. Chi-square test was used in statistical analyses, and the significance level was set as p < 0.05. Results In the study group, 25.4% of the healthcare staff stated that they were hesitant about vaccines in childhood. Also, 18.2% of the individuals indicated that they were hesitant about vaccines due to the chemicals in vaccines, 14.4% were hesitant due to the pharmaceutical industry and the relationships based on self-interest and 10.5% were hesitant due to the side effects. The hesitancy level was significantly higher among those whose source of information regarding vaccines in childhood was the internet (37.0%) compared with those whose source was not the internet (21.6%) (p = 0.004). Conclusions One-fourth of the healthcare staff, who are supposed to be the most informed group about vaccines, were hesitant about them. Moreover, the inaccurate information acquired from the internet and social media could be increasing the hesitancy level. Key messages Vaccination hesitancy is high among the healthcare staff in primary healthcare services. The source of information regarding vaccination influences the hesitancy levels of individuals.

scholarly journals The use of primary health care services after transformation in health and related factors in a province exampleBir il örneğinde sağlıkta dönüşüm sonrası I. basamak sağlık hizmetleri kullanımı ve ilişkili faktörler

2017 ◽  
Vol 14 (4) ◽  
pp. 4546 ◽  
Author(s):  
Emine Öncü ◽  
Sümbüle Köksoy Vayısoğlu ◽  
Ezgi Önen
Keyword(s):  
Chronic Disease ◽  
Family Practice ◽  
Primary Healthcare ◽  
Structural Characteristics ◽  
Healthcare Services ◽  
T Test ◽  
Factors Affecting ◽  
The Public ◽  
Significant Difference ◽  
The Family

Introduction: Health reforms that have been put into practice in our country within the scope of the Transformation in Health process have brought about with them significant changes in the organization, human labor and financing structures of healthcare services. Community healthcare centers have been replaced by family practice system at the primary level. The results of this change should be evaluated by monitoring the health indicators of the public as well as their use of healthcare services.Purpose: The objective of this study was to determine the factors affecting the access to family practice (FP) service at the Mersin provincial center along with the factors affecting the use of this service.      Method: Data of this cross-sectional study were acquired via face-to-face interviews carried out with 394 adult individuals at the Mersin city center during the dates of 14.02.2017– 30.07.2017. The structural characteristics of the healthcare services along with service satisfaction for primary healthcare services were evaluated in the study using the developed question form. The acquired data were analyzed via SPSS 21 package software with complementary statistics and independent T test, Chi-square test and ANOVA.  Results: The age average of the participants was 42.08±1.30 years, 5.3% had not received formal education, there was a child under the age of five in 34.0% of the households and a chronic disease in 36.8%; those who used the primary healthcare services had mostly done so for treatment purposes. Of the participants, 63.5% evaluated family practice service as very good/good and the secondary or tertiary healthcare services were the first points of contact for 51.1% in case of health related issues. The most frequently observed problems for family practice were determined as failure to reach family practice when the family practice is closed, lack of house visits and the inability to operate the transfer services. Whereas age, education, regular income job, pregnancy/birth in the household did not result in any statistically significant difference with regard to the fundamental structural characteristics for the primary services (p>0.05), there were differences with regard to the region of residence, gender, marital status, existence of a small child in the household and the existence of a chronic disease (p<0.05).Conclusion: Even though adults are mostly registered in the family practice system and majority have rated the family practice services as “very good/good”, FP services need to be developed for access to services, comprehensive service provision and coordination with secondary/tertiary services.Suggestion: Studies for developing the culture of using primary healthcare services among the public via household visits are suggested in addition to activities for strengthening family practice services qualitatively and quantitatively.Extended English abstract is in the end of Full Text PDF (TURKISH) file.ÖzetGiriş: Ülkemizde Sağlıkta Dönüşüm süreci ile uygulamaya geçirilmiş olan sağlık reformları sağlık hizmetlerinin örgüt, insan gücü ve finansman yapısında önemli değişimleri beraberinde getirmiştir. Birinci basamakta sağlık ocaklarının yerini aile hekimliği sistemi almıştır. Bu değişimin sonuçları sağlık göstergelerinin izlenmesi kadar halkın sağlık hizmetlerini kullanımı ile de değerlendirilmelidir.Amaç: Yapılan bu çalışma ile bir il merkezinde halkın aile hekimliği hizmetlerini kullanımı ve ilişkili faktörlerin değerlendirilmesi amaçlandı.Yöntem: Kesitsel nitelikteki bu çalışmanın verileri 14.02.2017- 30.07.2017 tarihleri arasında Mersin merkezde 394 yetişkin bireyle yüz yüze görüşülerek toplandı. Çalışmada araştırmacılarca oluşturulan soru formu ile I. basamak sağlık hizmetlerinin yapısal özellikleri ve hizmet memnuniyeti değerlendirildi. Elde edilen veriler SPSS 21 paket programı kullanılarak tanımlayıcı istatistikler ile independent T test, Ki Kare testi ve ANOVA kullanılarak çözümlendi.   Bulgular: Araştırmaya katılanların yaş ortalaması 42.08±1.30 yıldı, %5.3’ü örgün eğitim almamıştı, hanelerin %34.0’ında beş yaş altı çocuk, %36.8’inde kronik hastalık vardı, birinci basamak hizmeti kullananlar sıklıkla tedavi amaçlı hizmet almıştı.  Katılımcıların %63.5’i aile hekimliği hizmetini çok iyi/iyi olarak değerlendirmişti, %51.1’inin sağlıkla ilgili sorunu olduğunda ilk başvurduğu yer II. veya III. basamak hizmetlerdi. Aile hekimliğinde en fazla sorun alanlarının aile hekimliği kapalı iken aile hekimliğine ulaşamama, ev ziyaretleri yapılmaması ve sevk sisteminin işletilememesi ile ilgili olduğu tespit edildi. Yaş, eğitim, düzenli gelir getiren iş varlığı, ailede gebelik/doğumun olması I. basamağa ilişkin temel yapısal özelliklere ait puan ortalamaları yönüyle fark yaratmazken (p>0.05), ikamet edilen bölgeye, cinsiyete, evli olma durumuna, ailede küçük çocuk varlığına ve kronik hastalık varlığına göre fark vardı (p<0.05).Sonuç: Yetişkinlerin büyük ölçüde aile hekimliği sistemine kayıtlı olması ve çoğunluğun aile hekimliği hizmetlerini “çok iyi /iyi” olarak değerlendirmesine rağmen hizmetlere ulaşım, kapsamlı hizmet sunumu ile II/ III. basamak hizmetlerle eşgüdümü sağlama yönünden AH hizmetlerinin geliştirilmesi gerekmektedir.Öneriler: Nicelik ve nitelik olarak aile hekimliği hizmetlerinin güçlendirilmesi yanında düzenli ev ziyaretleri ile halk arasında birinci basamak sağlık hizmetlerinin kullanım kültürünü geliştirmeye dönük çalışmaların yapılması önerilir.

scholarly journals Dysglycemia-based Chronic Disease—Diabetes Re-worked

2018 ◽  
Vol 14 (2) ◽  
pp. 77
Author(s):  
Jeffrey I Mechanick ◽  
Keyword(s):  
Chronic Disease ◽  
Health Care Professionals ◽  
Disease Model ◽  
Vascular Complications ◽  
Cost Effective ◽  
Effective Care ◽  
P Type ◽  
Complex Chronic Disease

Type 2 diabetes (T2D) is a complex, chronic disease with a significant quality of life burden for affected individuals, as well as socio-economic burdens on a population scale. Efforts to mitigate morbidity, mortality, and risks for other acute and chronic diseases have been compromised by a traditional chronic disease model that focuses on tertiary prevention (i.e., waiting until the disease is fully manifest and in many cases with severe complications). More specifically, the role for prevention at an earlier “prediabetes” stage has been questioned. A re-examination of the biology and clinical data on T2D pathogenesis can modulate the way we think about T2D. The new Dysglycemia-Based Chronic Disease (DBCD) model addresses these challenges by positioning T2D and prediabetes along a continuous spectrum from insulin resistance to prediabetes to T2D to vascular complications. It is hoped that by conceptualizing T2D in the DBCD framework, health care professionals can provide more efficient, cost-effective care.

Research in palliative care

2021 ◽  
pp. 1261-1267
Author(s):  
Marianne J. Hjermstad ◽  
Stein Kaasa
Keyword(s):  
Palliative Care ◽  
Improve Patient Care ◽  
Cost Effective ◽  
Healthcare Services ◽  
Evidence Base ◽  
Ageing Population ◽  
High Quality Research ◽  
Care Research ◽  
Levels Of Care ◽  
Protocol Development

High-quality research in palliative care is a prerequisite for improving the evidence base, and closing the gap between knowledge and practice to improve patient care. Palliative care research is demanding, as it implies a huge diversity of healthcare services at different levels of care, delivered by multiple professions to vastly different populations. The need for evidence-based, efficient, and cost-effective services is evident, given the rapidly ageing population who live longer with serious and complex illnesses. This calls for collaborative research efforts focusing on both patient-centred and disease-centred outcomes during the disease trajectories and care pathways. This chapter discusses a range of topics focusing on why and how to conduct research in palliative care, and provides information on how to start, proceed, and complete sound research projects, as effectively and targeted as possible. Topics include, among others, challenges in palliative care research, research governance and ethical considerations, controlled clinical trials, and trial planning (including designs, methodology, collaboration, randomization, protocol development, statistical considerations, study conduct, including defining and including patients, randomization, and publication).

scholarly journals Community residents’ preferences for chronic disease management in Primary Care Facilities in China: a stated preference survey

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Xianglin Li ◽  
Mingzhu Jiang ◽  
Yingying Peng ◽  
Xiao Shen ◽  
Erping Jia ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Diseases ◽  
Primary Healthcare ◽  
Chronic Disease Management ◽  
Healthcare Services ◽  
Modern Medicine ◽  
Policy Makers ◽  
Care Facilities

Abstract Background Although Chinese government has dedicated the past decades to treating chronic diseases by primary healthcare system, many more residents are apt to choose higher-tier facilities to treat minor chronic diseases. Understanding residents’ preferences for chronic disease management in primary care facilities can bridge the gap between residents’ choices and policy implementation. This study aims to elicit residents’ preferences for chronic disease management in primary care facilities in the hypothetical minor chronic disease scenario. Methods Six hundred eighty residents were administered a discrete choice experiment that elicited preferences for chronic disease management in primary care facilities. Services attributes were service mode, treatment measure, out-of-pocket expenditure (OOP), traveling time to healthcare facility and title of physician. Mixed logit models were used to estimate stated preferences and willingness to pay for attributes. WTP confidence intervals were estimated by the delta method. Results A total of 94.44% of the completed questionnaires were valid (680 of 720 respondents). The participants preferred chronic disease management service with modern medicine, traveling time ≤ 30mins, and less OOP expenditure. Compared with Traditional Chinese Medicine (TCM), residents prefer modern medicine, willing to pay 155.53 CNY ($21.97) to change from TCM to modern medicine. Compensation about 86.02 CNY ($12.15) was needed to enable residents to change the choice of the nearer primary care facility to a further one. Integrated medicine in community clinics by experts was residents’ most preferred scenario while TCM in the tertiary hospital was their least preferred one. Conclusion In order to increase the utilization of primary healthcare services in chronic diseases management, policy makers need to concern more about the services of medical treatment type, price and convenience. Therefore, we advise policy makers to provide nearer primary healthcare services for residents especially for residents in surrounding areas. Furthermore, balancing the resource allocation between Traditional Chinese Medicine and modern medicine is worthy of consideration.

scholarly journals Preferences for Primary Healthcare Services Among Older Adults with Chronic Disease: A Discrete Choice Experiment

2020 ◽  
Vol Volume 14 ◽  
pp. 1625-1637
Author(s):  
Yingying Peng ◽  
Mingzhu Jiang ◽  
Xiao Shen ◽  
Xianglin Li ◽  
Erping Jia ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Disease ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Primary Healthcare ◽  
Choice Experiment ◽  
Healthcare Services

Characteristics of nursing encounters in primary healthcare in remote areas: A survey of nurses’ patient record documentation and self-report

2020 ◽  
pp. 205715852097316
Author(s):  
Anna Lundberg ◽  
Lina Gyllencreutz ◽  
Britt-Inger Saveman ◽  
Erika Boman
Keyword(s):  
Primary Healthcare ◽  
Healthcare Services ◽  
Self Report ◽  
Patient Record ◽  
Scope Of Practice ◽  
Remote Communities ◽  
Remote Areas ◽  
Self Reports ◽  
Island Community

To meet both current and future competence needs, improved and updated understanding of nurses’ scope of practice when working in remote communities is needed. The aim was to describe and analyze the characteristics of nursing encounters in primary healthcare in remote areas. The setting for the study was an island community in Finland. Nurses’ patient record documentation and self-reports on patient encounters were surveyed ( n = 1062). Patients aged ≥65 years accounted for most encounters. Great variety in the encounters was seen, though some nursing tasks and patient conditions were overrepresented. For patient safety reasons, it is important to review how nurses maintain competence regarding those tasks and conditions encountered less often. Primary healthcare services should focus on the broader determinants of health. However, a more disease-oriented focus was seen. To ensure quality of care in primary healthcare in remote areas, there is a need for standardized routines for monitoring patients and documenting findings and performed interventions.

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