scholarly journals Round table: Applying multidisciplinary sciences to improve paediatric primary care for children in Europe

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
Keyword(s):  
Primary Care ◽  
Child Health ◽  
Common Knowledge ◽  
Round Table ◽  
Well Being ◽  
Round Table Discussion ◽  
Philosophical Perspective ◽  
Long Term Conditions ◽  
Paediatric Primary Care ◽  
Multidisciplinary Sciences

Abstract Considerable progress has been made in improving child health and well-being in Europe over the past 40 years, with great reductions in neonatal, and child deaths, and in deaths from causes such as vaccine-preventable diseases. Paediatric primary care (PPC) has significantly contributed to these advances. However, there are still differences between and within countries regarding the content and organizations of primary care for children that might have an impact on important aspects such as access and availability of primary care. These cross-country and within-country differences together with current and future challenges in child health care, such as increasing prevalence of chronic and long-term conditions, fragmentation of care and shortage of health personnel, pose a complex challenge for European countries. Working towards an approach to tackle these challenges requires the vision, input and collaboration of multidisciplinary sciences. In this workshop four perspectives are brought together with the goal to learn from each other’s experiences and to establish a common knowledge base on how to collaborate between different disciplines and sciences to bring PPC to a next level. The first presentation will be from a public health perspective and is about the comparison of actual and desired organization and content of adolescent health services. The second presentation will be a paediatrician’s perspective and stresses the importance of an adequately trained paediatric workforce. The third presentation will be from a sociological perspective and focuses on the societal scale drivers framing health among children and their families. In the final presentation a philosophical perspective will be given on adherence to therapy, resilience and resonance in the treatment triangle of ‘patient-family-therapist’. The presentations will be followed by a round table discussion in which the audience will be involved: the presenters will answer questions and discuss with the audience how we should create better and sustainable PCP by making use of multiple disciplines and sciences. Key messages Differences between and within countries regarding the content and organizations of primary care for children might have an impact on important aspects such as access and availability of primary care. Working towards an approach to tackle challenges in paediatric primary care requires the vision, input and collaboration of multidisciplinary sciences.

Preventive Pediatrics—New Models of Providing Needed Health Services

PEDIATRICS ◽  
1995 ◽  
Vol 95 (5) ◽  
pp. 758-762 ◽  
Author(s):  
Barry Zuckerman ◽  
Steven Parker
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Child Development ◽  
Managed Care ◽  
Child Health ◽  
Care Setting ◽  
Primary Care Setting ◽  
Well Being ◽  
Pediatric Primary Care ◽  
Children And Families

The risks to children's well-being are accelerating because, in part, of an increasingly porous social safety net. Pediatricians are being asked to bear an ever-increasing burden for helping children and families address a myriad of issues, and they have become the providers of last resort. As the distance between what we should do and what we can do as clinicians widens, so too does our frustration and willingness to consider addressing yet one more issue. We often retreat to the comfortable world of otitis media and immunizations and shut out the loud cacophony of the outside world and its effects on our families. We need a new model of care, based on an ecological approach to child health consistent with Bright Futures,40 which provides child health supervision guidelines. To meet these needs, some settings may develop models in which skilled professionals can provide advocacy services, parental health, parental mental health, and child development services in the context of pediatric practice. Although most practices or clinic programs will not have the space or resources to include all of these services, the development and implementation of any one of them will enrich the care of children and families. Other services such as legal aid, family literacy, and mental health may be available in the community and could be colocated in the pediatric setting as outreach efforts on the part of these programs or linked in a manner that ensures accessibility. Similar enhancements to primary-care programs for special groups of children at risk, including those who are homeless, drug exposed, in foster care, and born to teen-age mothers, are being developed in many communities. The cost of such services presents difficult obstacles. However, given the progressive growth of prepaid practices and competition among plans for patients, services such as those provided by a child development specialist might increase the attractiveness of the plan and allow recruitment of more families. Reducing cigarette smoking, preventing unwanted pregnancy, and reducing drug and alcohol use have potential cost-saving implications that will interest managed-care programs. On the other hand, health care plans may limit services if potential financial benefits are uncertain or acrue to another sector such as schools. For populations at risk, especially health-education collaboration of this type (whether funded and/or cofunded with funds from federal or state department of education budgets, Medicaid, managed-care contracts, tobacco tax revenues, and/or federal family planning funds) should be pursued. Most of the services we have described are, in fact, already available in most communities and/or health plans. Without new net costs, it may be possible to reallocate some or all of these services to the pediatric primary-care setting in a single-site, one-stop-shopping model. Redeploying services to the pediatric primary-care setting may increase accessibility to these important preventive services and improve the health and well-being of children and their parents.

scholarly journals The Patient Centred Assessment Method for improving nurse-led biopsychosocial assessment of patients with long-term conditions: a feasibility RCT

2018 ◽  
Vol 6 (4) ◽  
pp. 1-120 ◽  
Author(s):  
Margaret Maxwell ◽  
Carina Hibberd ◽  
Patricia Aitchison ◽  
Eileen Calveley ◽  
Rebekah Pratt ◽  
...  
Keyword(s):  
Primary Care ◽  
Data Collection ◽  
Well Being ◽  
Assessment Method ◽  
Long Term Conditions ◽  
Five Practices ◽  
Biopsychosocial Assessment ◽  
Mental Well Being

Background Annual reviews of people living with long-term conditions (LTCs) are mostly conducted by practice nurses (PNs), who focus on the physical needs of patients. The broader mental well-being and social needs of patients are also important if they are to live well. The Patient Centred Assessment Method (PCAM) is a new tool to help PNs conduct biopsychosocial assessments of patients’ needs. Research questions Is it feasible and acceptable to use the PCAM in primary care nurse-led reviews for those with LTCs? Is it feasible and acceptable to run a cluster randomised trial of the PCAM in primary care? Methods Four practitioner and two patient focus groups explored the acceptability and implementation requirements of the PCAM, which was then tested in a feasibility cluster randomised controlled trial aiming to recruit eight general practitioner (GP) practices and 16 nurses. Baseline data collection was conducted with nurses prior to randomisation, with a cohort of 10 patients per nurse, including patient demographics, patient evaluation of consultation, patient-completed outcomes (measured via the Consultation and Relational Empathy, Patient Enablement Instrument, Warwick–Edinburgh Mental Well-Being Scale, General Health Questionnaire and the Short Form questionnaire-12 items) and nurse referrals/signposting to services. Patient follow-up questionnaires were completed at 8 weeks. Practices were then randomised to the PCAM intervention or care as usual (CAU). Data collection was repeated for a second cohort of patients. Fidelity was tested by comparing a sample of recorded consultations before and after PCAM training. Qualitative interviews were conducted with PCAM nurses and a sample of patients. Results Approaches to 159 eligible practices resulted in the recruitment of six practices (10 nurses), with five practices (seven nurses) completing both data collection phases. Nurses collected baseline data on 113 patients, 71 of whom (62.8%) completed follow-up questionnaires. Five practices were randomised: three practices (six nurses) to the PCAM arm and two practices (four nurses) to the CAU arm. In phase 2, seven nurses collected data on 77 patients, of whom 40 (52%) completed follow-up. Only four PCAM nurses agreed to recording consultations, with five pre- and four post-PCAM recordings obtained. Post PCAM training, there was evidence of more attention being given to patients’ mental well-being and social issues. The PCAM was fairly easily integrated into consultation, although some nurses reflected that this benefited from early support. Patients were not always aware of its use, but most were happy to have their needs assessed. Limitations Recruitment of GP practices, and nurse recruitment and retention. Conclusions The PCAM is feasible and acceptable for use by primary care nurses and may have potential for encouraging biopsychosocial assessment of patients. Efforts required to recruit and retain staff indicate that a full trial is not feasible or cost-effective at this time. Future work The PCAM intervention warrants further exploration as an effective mechanism for improving care for people with LTCs; this could be conducted within an implementation study. Trial registration Current Controlled Trials ISRCTN98973169. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research Vol. 6, No. 4. See the NIHR Journals Library website for further project information.

scholarly journals The efficacy of primary care chaplaincy compared with antidepressants: a retrospective study comparing chaplaincy with antidepressants

2017 ◽  
Vol 18 (04) ◽  
pp. 354-365 ◽  
Author(s):  
Gordon Macdonald
Keyword(s):  
Primary Care ◽  
Demographic Data ◽  
Well Being ◽  
Evidence Base ◽  
Post Intervention ◽  
Long Term Conditions ◽  
Meaningful Improvement ◽  
The United Kingdom ◽  
Significant Difference ◽  
Need To Evaluate

AimTo determine the effectiveness of primary care chaplaincy (PCC) when used as the sole intervention, with outcomes being compared directly with those of antidepressants. This was to be carried out in a homogenous study population reflective of certain demographics in the United Kingdom.BackgroundIncreasing numbers of patients are living with long-term conditions and ‘modern maladies’ and are experiencing loss of well-being and depression. There is an increasing move to utilise non-pharmacological interventions such as ‘talking therapies’ within this context. Chaplaincy is one such ‘talking therapy’ but within primary care its evidence base is sparse with only one quantitative study to date. There is therefore a need to evaluate PCC excluding those co-prescribed antidepressants, as this is not evidenced in the literature as yet. PCC also needs to be directly compared with the use of antidepressants to justify its use as a valid alternative treatment for loss of well-being and depression.MethodsThis was a retrospective observational study based on routinely collected data. There were 107 patients in the PCC group and 106 in the antidepressant group. Socio-demographic data were collected. Their pre- and post-intervention (either chaplaincy or antidepressant) well-being was assessed, by the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) which is a validated Likert scale.FindingsThe majority of both groups were female with both groups showing marked ethnic homogeneity. PCC was associated with a significant and clinically meaningful improvement in well-being at a mean follow-up of 80 days. This treatment effect was maintained after those co-prescribed antidepressants were removed. PCC was associated with an improvement in well-being similar to that of antidepressants with no significant difference between the two groups.

Perceived partner responsiveness, responsive parenting and child health and well-being

2014 ◽  
Author(s):  
Heidi Kane ◽  
Erin T. Tobin ◽  
Daniel J. Saleh ◽  
Sylvie Naar-King ◽  
Wayne Pierantoni ◽  
...  
Keyword(s):  
Child Health ◽  
Well Being ◽  
Responsive Parenting ◽  
Perceived Partner Responsiveness ◽  
Partner Responsiveness ◽  
Health And Well Being ◽  
And Child Health

scholarly journals Prepared and highly committed despite the risk of COVID-19 infection: a cross-sectional survey of primary care physicians’ concerns and coping strategies in Singapore

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jerrald Lau ◽  
David Hsien-Yung Tan ◽  
Gretel Jianlin Wong ◽  
Yii-Jen Lew ◽  
Ying-Xian Chua ◽  
...  
Keyword(s):  
Primary Care ◽  
Coping Strategies ◽  
Stress Management ◽  
Primary Care Physicians ◽  
Well Being ◽  
Pandemic Preparedness ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Accessible Information ◽  
And Coping

Abstract Background Primary care physicians (PCPs) are first points-of-contact between suspected cases and the healthcare system in the current COVID-19 pandemic. This study examines PCPs’ concerns, impact on personal lives and work, and level of pandemic preparedness in the context of COVID-19 in Singapore. We also examine factors and coping strategies that PCPs have used to manage stress during the outbreak. Methods Two hundred and sixteen PCPs actively practicing in either a public or private clinic were cluster sampled via email invitation from three primary care organizations in Singapore from 6th to 29th March 2020. Participants completed a cross-sectional online questionnaire consisting of items on work- and non-work-related concerns, impact on personal and work life, perceived pandemic preparedness, stress-reduction factors, and personal coping strategies related to COVID-19. Results A total of 158 questionnaires were usable for analyses. PCPs perceived themselves to be at high risk of COVID-19 infection (89.9%), and a source of risk (74.7%) and concern (71.5%) to loved ones. PCPs reported acceptance of these risks (91.1%) and the need to care for COVID-19 patients (85.4%). Overall perceived pandemic preparedness was extremely high (75.9 to 89.9%). PCPs prioritized availability of personal protective equipment, strict infection prevention guidelines, accessible information about COVID-19, and well-being of their colleagues and family as the most effective stress management factors. Conclusions PCPs continue to serve willingly on the frontlines of this pandemic despite the high perception of risk to themselves and loved ones. Healthcare organizations should continue to support PCPs by managing both their psychosocial (e.g. stress management) and professional (e.g. pandemic preparedness) needs.

scholarly journals European consensus on essential steps of Minimally Invasive Ivor Lewis and McKeown Esophagectomy through Delphi methodology

2021 ◽  
Author(s):  
Yassin Eddahchouri ◽  
◽  
Frans van Workum ◽  
Frits J. H. van den Wildenberg ◽  
Mark I. van Berge Henegouwen ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Expert Panel ◽  
Minimally Invasive Esophagectomy ◽  
Round Table ◽  
Round Table Discussion ◽  
Ivor Lewis ◽  
Delphi Methodology ◽  
Invasive Esophagectomy ◽  
European Consensus ◽  
Mckeown Esophagectomy

Abstract Background Minimally invasive esophagectomy (MIE) is a complex and technically demanding procedure with a long learning curve, which is associated with increased morbidity and mortality. To master MIE, training in essential steps is crucial. Yet, no consensus on essential steps of MIE is available. The aim of this study was to achieve expert consensus on essential steps in Ivor Lewis and McKeown MIE through Delphi methodology. Methods Based on expert opinion and peer-reviewed literature, essential steps were defined for Ivor Lewis (IL) and McKeown (McK) MIE. In a round table discussion, experts finalized the lists of steps and an online Delphi questionnaire was sent to an international expert panel (7 European countries) of minimally invasive upper GI surgeons. Based on replies and comments, steps were adjusted and rephrased and sent in iterative fashion until consensus was achieved. Results Two Delphi rounds were conducted and response rates were 74% (23 out of 31 experts) for the first and 81% (27 out of 33 experts) for the second round. Consensus was achieved on 106 essential steps for both the IL and McK approach. Cronbach’s alpha in the first round was 0.78 (IL) and 0.78 (McK) and in the second round 0.92 (IL) and 0.88 (McK). Conclusions Consensus among European experts was achieved on essential surgical steps for both Ivor Lewis and McKeown minimally invasive esophagectomy.

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