scholarly journals Access to emergency care units by socially vulnerable patients: a qualitative research

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Vieille ◽  
M Rotily ◽  
T Apostolidis ◽  
N Persico ◽  
A Galinier
Keyword(s):  
Primary Care ◽  
Emergency Care ◽  
Social Inequalities ◽  
Emergency Services ◽  
Social Representations ◽  
Healthcare Services ◽  
Medical Attention ◽  
New Information ◽  
Vulnerable Patients ◽  
Emergency Care Units

Abstract Background The increasing prevalence of chronic diseases, the decline in medical demography, the ramp up of new information and diagnosis technologies, together with the growing health social inequalities urge decision makers to rethink the access to emergency care units (ECU) and reduce the rate of multiple admissions, especially for people living in vulnerable conditions. Beyond the medical causes of access to ECU, it is crucial to understand the psychosocial representations of patients and health professionals. Methods 23 socially vulnerable patients who have already been admitted within the last 3 months and ECU health/social professionals were interviewed face-to-face by a psychosocial scientist using a semi-directed approach, in 3 hospitals. The thematic content of data was analyzed in order to identify salient social representations of access to ECU. Results 27 themes emerged to understand the issue of the access to ECU, joining into 5 main categories: perceived needs for access to ECU, perception of precariousness, the relationship of patients and professionals with the healthcare system, the shared experience of aggressiveness in ECU, expectations in post-emergency support. As regards the needs for access to ICU, several issues were identified: exemption from making upfront payments, needs for listening, support, reinsurance, privacy and consideration of emergency professionals, referral by general practitioners (GP), difficult access to GP, needs for immediacy and timely healthcare services, permanent opening of ECU. As regards the experience of ECU professionals: ambivalent emotions towards socially vulnerable patients, a recurrence of passages leading to a reduced medical attention, a feeling of failure to care for vulnerable patients, coping strategies in caring for these patients. Conclusions Our results bring several leads to improve the organization and the management of healthcare in ECU and in primary care for socially vulnerable patients. Key messages To identify the psychosocial rationales of access to emergency care units provides several leads to build a more efficient healthcare policy and reduce the burden of overloaded services. To reduce the overburden of emergency services can only be achieved by a global approach of the access to both emergency and primary care and a better support after emergency discharge.

scholarly journals Counter-referral in Emergency Care Units: discourse of the collective speech

2019 ◽  
Vol 72 (suppl 1) ◽  
pp. 143-150
Author(s):  
Patrícia Madalena Vieira Hermida ◽  
Eliane Regina Pereira do Nascimento ◽  
Maria Elena Echevarría-Guanilo ◽  
Selma Regina de Andrade ◽  
Ângela Maria Blatt Ortiga
Keyword(s):  
Primary Care ◽  
Interpersonal Relationships ◽  
Emergency Care ◽  
Theoretical Basis ◽  
National Policy ◽  
Structured Interview ◽  
Local Health ◽  
State Method ◽  
Local Health System ◽  
Emergency Care Units

ABSTRACT Objective: To describe the facilities and difficulties of the counter-referral of an Emergency Care Unit in Santa Catarina State. Method: Descriptive, qualitative study, with the participation of three nurses and 17 physicians. The data were collected through a semi-structured interview and analyzed using the Discourse of the Collective Subject technique. For the theoretical basis, the Política Nacional de Atenção às Urgências (National Policy of Emergency Care) and the Rede de Atenção às Urgências (Network of Care to the Emergencies) was used. Results: The facilities of the counter-referral correspond to the strategies of communication with the Primary Care: embracement; good interpersonal relationships; and electronic medical record network. The difficulties are related to the deficiencies of Primary Care and specialized services, such as the insufficient number of physicians and the delay in scheduling consultations and more complex exams. Final considerations: The difficulties highlighted indicate significant challenges of the local health system in the search for integration between emergency care points.

scholarly journals Emergency care units and dimensions of accessibility to health care for the elderly

2018 ◽  
Vol 71 (suppl 2) ◽  
pp. 811-817 ◽  
Author(s):  
Giovana Aparecida de Souza Scolari ◽  
Leidyani Karina Rissardo ◽  
Vanessa Denardi Antoniassi Baldissera ◽  
Lígia Carreira
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Quality Of Care ◽  
Elderly Patients ◽  
Emergency Care ◽  
Elderly Population ◽  
The Elderly ◽  
Care For The Elderly ◽  
Emergency Care Units

ABSTRACT Objective: to understand the conception of the elderly and their caregivers about the accessibility to health mediated by the service in Emergency Care Units. Methodo: a qualitative study conducted with 25 elderly patients and caregivers at Emergency Care Units in a city of Paraná, using Grounded Theory as a methodological reference. Results: According to the participants, the resources available in these services guarantee medical consultation and provide access to exams and medicines. Such resources have attracted patients and caused excess demand, which implies a set of compromising factors for the quality of care in these services. Final considerations: Investments in the restructuring of the care network, especially in primary care, with an increase in the number of consultations and the creation of a bond, can contribute to the emergency care units achieving the goal of access to qualified assistance to the elderly population.

scholarly journals Does socially differentiated cardiac rehabilitation affect the use of healthcare services after myocardial infarction? A 10-year follow-up study

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e030807
Author(s):  
Kathrine Hald ◽  
Lucette Kirsten Meillier ◽  
Kirsten M. Nielsen ◽  
Finn Breinholt Larsen ◽  
Martin Berg Johansen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
General Practice ◽  
Cardiac Rehabilitation ◽  
Chronic Care ◽  
Social Inequalities ◽  
Healthcare Services ◽  
University Hospital ◽  
First Episode ◽  
Vulnerable Patients

ObjectiveTo examine the long-term effect of a socially differentiated cardiac rehabilitation (CR) intervention tailored to reduce social inequalities in health regarding use of healthcare services in general practice and hospital among socially vulnerable patients admitted with first-episode myocardial infarction (MI).DesignA prospective cohort study with 10 years’ follow-up.SettingDepartment of cardiology at a university hospital in Denmark between 2000 and 2004.ParticipantsPatients <70 years admitted with first-episode MI categorised as socially vulnerable (n=208) or non-socially vulnerable (n=171) based on educational level and social network.InterventionA socially differentiated CR intervention. The intervention consisted of standard CR and expanded CR with focus on cross-sectional collaboration.Main outcome measuresParticipation in annual chronic care consultations in general practice, contacts to general practice, all-cause hospitalisations and cardiovascular readmissions.ResultsAt 2-year and 5-year follow-up, socially vulnerable patients receiving expanded CR participated significantly more in annual chronic care consultations (p=0.02 and p<0.01) but at 10-year follow-up, there were no significant differences in annual chronic care consultations (p=0.13). At 10-year follow-up, socially vulnerable patients receiving standard CR had significantly more contacts to general practice (p=0.03). At 10-year follow-up, there were no significant differences in the proportion of socially vulnerable patients receiving expanded CR in the mean number of all-cause hospitalisations and cardiovascular readmissions (p>0.05).ConclusionsThe present study found no persistent association between the socially differentiated CR intervention and use of healthcare services in general practice and hospital in patients admitted with first-episode MI during a 10-year follow-up.

scholarly journals Evaluation of the use of services provided by emergency care units in a Brazilian municipality

2016 ◽  
Vol 64 (4) ◽  
pp. 411-418
Author(s):  
Lubieska Rangel ZANON ◽  
Luciane ZANIN ◽  
Flávia Martão FLÓRIO
Keyword(s):  
Health Service ◽  
Emergency Care ◽  
Emergency Services ◽  
Action Plan ◽  
Healthcare Facilities ◽  
Basic Health ◽  
Validated Questionnaire ◽  
Trained Interviewer ◽  
Basic Health Units ◽  
Emergency Care Units

ABSTRACT Objective: To characterize the users and to analyze the factors that determine their choice in using the emergency services. Methods: The study was carried out in the two Emergency Care Units in Serra (Espírito Santo, Brazil). With regard to those users seeking the services of these Emergency Care Units, a trained interviewer approached 1 out of every 4 adults classified in the nursing consultation as not relevant to the Service ("false demand"), amounting to a total of 390 interviews. Using a validated questionnaire, the interview was conducted in accordance with the policies set out in the Health Service Action Plan. 80% of the demand was classified as not relevant. Results: The "false demand" was chiefly composed of women (55.1%), educated to a level between high school and incomplete higher education (69.4%) and 14.6% were enrolled in private health plans. 78.5% had not previously sought any health service, in view of the ostensible guarantee of same-day care (43.1%) or the difficulty in receiving care in the basic health units (37.9%). Conclusion: The majority of consultations performed in the Emergency Care Units should be resolved in basic healthcare facilities. The "false demand" is related to the reported difficulties the basic health units have in providing the necessary care and their ability to resolve the problem.

scholarly journals An Integrated Emergency Response Tool for Developing Countries: Case of Uganda

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Swaib Kyanda Kaawaase ◽  
Rodney Ekisa Simon
Keyword(s):  
Developing Countries ◽  
Social Services ◽  
Emergency Response ◽  
Emergency Care ◽  
Emergency Services ◽  
Healthcare Services ◽  
Future Studies ◽  
Emergency Response System ◽  
Response System ◽  
Strategic Plans

This paper presents a First responder emergency response tool (EMApp) as a step towards achieving integrated emergency care in developing countries, the case of Uganda. The EMApp prototype has potential to support health emergency response from various emergency stakeholders. This innovation is in line with strategic plans to embrace technologies towards the establishment of integrated social services such as emergency healthcare services (EHS) in Uganda. We describe the prototype and provide its functionalities that can be further enhanced to enable access to emergency services and save life. The possible assumptions, potential challenges and recommendations to implement and deployment of such a system are provided. There is currently no such integrated emergency response system in Uganda as is the case in many other developing countries. For future studies, there is need to deploy the tool and assess its impact on the communities.

scholarly journals Structuring methodology of the Computerized Nursing Process in Emergency Care Units

2018 ◽  
Vol 71 (3) ◽  
pp. 1079-1084 ◽  
Author(s):  
Fernanda Paese ◽  
Grace Teresinha Marcon Dal Sasso ◽  
Gabriela Winter Colla
Keyword(s):  
Emergency Care ◽  
Nursing Practice ◽  
Emergency Services ◽  
Nursing Interventions ◽  
Nursing Process ◽  
Clinical Evaluations ◽  
Version 2.0 ◽  
Solid Form ◽  
Emergency Care Units

ABSTRACT Objective: To structure the Computerized Nursing Process using the International Classification for Nursing Practice (ICNP®) version 2.0 to emergency care units in a computerized structure. Method: This is a methodological and technological research that followed the stages: (1) establishment of the development team and resources; (2) adequacy of clinical situations, diagnoses and nursing interventions for the emergency area; (3) association of diagnoses and interventions based on ICNP®; (4) organization and codification of clinical evaluation, diagnoses and nursing interventions; (5) transfer of data to the a computerized platform. Results: Readjustment and construction of 1,445 possibilities of clinical evaluations associated with 961 different diagnoses and their corresponding interventions to the most frequent situations in emergency services. Conclusion: ICNP® has a strong and solid form for the development of the computerized nursing process able to support nurses in safe decision-making to improve the quality of health care.

scholarly journals Long-term effectiveness of elderly health care voucher scheme strategies: a system dynamics simulation analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ka Chun Chong ◽  
Hong Fung ◽  
Carrie Ho Kwan Yam ◽  
Patsy Yuen Kwan Chau ◽  
Tsz Yu Chow ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Public Sector ◽  
System Dynamics ◽  
The Elderly ◽  
Healthcare Services ◽  
Dynamics Simulation ◽  
Public And Private ◽  
The Public ◽  
The Impact

Abstract Background The elderly healthcare voucher (EHCV) scheme is expected to lead to an increase in the number of elderly people selecting private primary healthcare services and reduce reliance on the public sector in Hong Kong. However, studies thus far have reported that this scheme has not received satisfactory responses. In this study, we examined changes in the ratio of visits between public and private doctors in primary care (to measure reliance on the public sector) for different strategic scenarios in the EHCV scheme. Methods Based on comments from an expert panel, a system dynamics model was formulated to simulate the impact of various enhanced strategies in the scheme: increasing voucher amounts, lowering the age eligibility, and designating vouchers for chronic conditions follow-up. Data and statistics for the model calibration were collected from various sources. Results The simulation results show that the current EHCV scheme is unable to reduce the utilization of public healthcare services, as well as the ratio of visits between public and private primary care among the local aging population. When comparing three different tested scenarios, even if the increase in the annual voucher amount could be maintained at the current pace or the age eligibility can be lowered to include those aged 60 years, the impact on shifts from public-to-private utilization were insignificant. The public-to-private ratio could only be marginally reduced from 0.74 to 0.64 in the first several years. Nevertheless, introducing a chronic disease-oriented voucher could result in a significant drop of 0.50 in the public-to-private ratio during the early implementation phase. However, the effect could not be maintained for an extended period. Conclusions Our findings will assist officials in improving the design of the EHCV scheme, within the wider context of promoting primary care among the elderly. We suggest that an additional chronic disease-oriented voucher can serve as an alternative strategy. The scheme must be redesigned to address more specific objectives or provide a separate voucher that promotes under-utilized healthcare services (e.g., preventive care), instead of services designed for unspecified reasons, which may lead to concerns regarding exploitation.

scholarly journals Delivering Community Emergency Medicine during the COVID-19 pandemic: the Physician Response Unit

2021 ◽  
Vol 38 (5) ◽  
pp. 371-372
Author(s):  
Rich Carden ◽  
Bill Leaning ◽  
Tony Joy
Keyword(s):  
Emergency Medicine ◽  
Emergency Care ◽  
Hospital Admissions ◽  
Hospital Setting ◽  
Response Unit ◽  
Care Services ◽  
Vulnerable Patients ◽  
Palliative Care Services ◽  
Alternative Solutions ◽  
Physician Response

The COVID-19 pandemic has presented significant challenges to services providing emergency care, in both the community and hospital setting. The Physician Response Unit (PRU) is a Community Emergency Medicine model, working closely with community, hospital and pre-hospital services. In response to the pandemic, the PRU has been able to rapidly introduce novel pathways designed to support local emergency departments (EDs) and local emergency patients. The pathways are (1) supporting discharge from acute medical and older people’s services wards into the community; (2) supporting acute oncology services; (3) supporting EDs; (4) supporting palliative care services. Establishing these pathways have facilitated a number of vulnerable patients to access patient-focussed and holistic definitive emergency care. The pathways have also allowed EDs to safely discharge patients to the community, and also mitigate some of the problems associated with trying to maintain isolation for vulnerable patients within the ED. Community Emergency Medicine models are able to reduce ED attendances and hospital admissions, and hence risk of crowding, as well as reducing nosocomial risks for patients who can have high-quality emergency care brought to them. This model may also provide various alternative solutions in the delivery of safe emergency care in the postpandemic healthcare landscape.

scholarly journals Analysis of Annual Costs of Mobile Clinics in the Southern United States

2020 ◽  
Vol 11 ◽  
pp. 215013272098062
Author(s):  
Sharon Attipoe-Dorcoo ◽  
Rigoberto Delgado ◽  
Dejian Lai ◽  
Aditi Gupta ◽  
Stephen Linder
Keyword(s):  
Primary Care ◽  
Healthcare Services ◽  
Medicare Beneficiaries ◽  
Mobile Clinic ◽  
Efficient Manner ◽  
Healthcare Facilities ◽  
Capital Costs ◽  
At Risk Populations ◽  
Mobile Clinics ◽  
The Cost

Introduction Mobile clinics provide an efficient manner for delivering healthcare services to at-risk populations, and there is a need to understand their economics. This study analyzes the costs of operating selected mobile clinic programs representing service categories in dental, dental/preventive, preventive care, primary care/preventive, and mammography/primary care/preventive. Methods The methodology included a self-reported survey of 96 mobile clinic programs operating in Texas, North Carolina, Georgia, and Florida; these states did not expand Medicaid and have a large proportion of uninsured individuals. Data were collected over an 8-month period from November 2016 to July 2017. The cost analyses were conducted in 2018, and were analyzed from the provider perspective. The average annual estimated costs; as well the costs per patient in each mobile clinic program within different service delivery types were assessed. Costs reported in the study survey were classified into recurrent direct costs and capital costs. Results Results indicate that mean operating costs range from about $300 000 to $2.5 million with costs increasing from mammography/primary care/preventive delivery to dental/preventive. The majority of mobile clinics provided dental care followed by dental/preventive. The cost per patient visit for all mobile clinic service types ranged from $65 to $529, and appears to be considerably less than those reported in the literature for fixed clinic services. Conclusion The overall costs of all delivery types in mobile clinics were lower than the costs of providing care to Medicare beneficiaries in federally funded health centers, making mobile clinics a sound economic complement to stationary healthcare facilities.

Sign in / Sign up

Export Citation Format

Share Document