scholarly journals Protocolled practice nurse-led care for children with asthma in primary care: protocol for a cluster randomised trial

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e022922
Author(s):  
Sara Bousema ◽  
Annemieke J Verwoerd ◽  
Lucas M Goossens ◽  
Arthur M Bohnen ◽  
Patrick J E Bindels ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
General Practitioner ◽  
Asthma Control ◽  
Practice Nurse ◽  
Asthma Care ◽  
Cluster Randomised ◽  
Children With Asthma

IntroductionIn children with asthma, daily symptoms and exacerbations have a significant impact on the quality of life of both children and parents. More effective use of asthma medication and, consequently, better asthma control is advocated, since both overtreatment and undertreatment are reported in primary care. Trials in adults suggest that asthma control is better when patients receive a regular medical review. Therefore, protocolled care by the general practitioner may also lead to better asthma control in children. However, such protocolled care by the general practitioner may be time consuming and less feasible. Therefore, this study aims to determine whether protocolled practice nurse-led asthma care for children in primary care provides more effective asthma control than usual care.Methods and analysisThe study will be a cluster-randomised open-label trial with an 18-month follow-up. Practice nurses will be the units of randomisation and children with asthma the units of analysis. It is planned to include 180 children aged 6–12 years. Primary outcome will be average asthma control during the 18-month follow-up measured by the Childhood Asthma Control Test (C-ACT). Secondary outcomes include C-ACT scores at t=3, t=6, t=12 and t=18 months; the frequency and severity of exacerbations; cost-effectiveness; quality of life; satisfaction with delivered care; forced expiratory volume in 1 s and forced expiratory flow at 75% and the association of high symptoms scores at baseline and baseline characteristics. Besides, we will conduct identical measurements in a non-randomised sample of children.Ethics and disseminationThis will be the first trial to evaluate the effectiveness of protocolled practice nurse-led care for children with asthma in primary care. The results may lead to improvements in asthma care for children and can be directly implemented in revisions of asthma guidelines.The study protocol was approved by the Medical Research Ethics Committee of the Erasmus Medical Centre in Rotterdam.Trial registrationNTR6847.

scholarly journals Factors related to perceived continuity of care in hospitalized cardiac patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Safstrom ◽  
T.J Jaarsma ◽  
L.N Nordgren ◽  
M.L Liljeroos ◽  
A.S Stomberg
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Health Care ◽  
Continuity Of Care ◽  
Perceived Control ◽  
Care Utilization ◽  
Funding Source ◽  
Patient Reported

Abstract Background Since healthcare systems are increasingly complex and often fragmented, continuity of care after hospitalization is a priority to increase patient safety and satisfaction. Aim Describe factors related to continuity of care in patients hospitalized due to cardiac conditions. Methods This cross-sectional multicenter study enrolled patients 6 weeks after hospitalization due to cardiac conditions. A total of 993 patients were included (mean age 72.2 (SD 10.4), males 66%) with AMI (35%), AF (25%), angina (21%) and HF (17.3%). Patients completed the Patient Continuity of Care Questionnaire, a questionnaire based on the definition that continuity of care is “the extent to which a series of health care services is experienced as connected and coherent and is consistent with a patient's health needs and personal circumstances”. The total score of the questionnaire ranges from 6 to 30, higher score indicating higher continuity and a score <24 indicating insufficient continuity. Cronbach's alpha on the total PCCQ was 0.94. Correlations between PCCQ and quality of life, depression, anxiety, perceived control and health care utilization were estimated using spearman rang correlation. Results Insufficient continuity of care ranged between 47% to 59% in the different diagnosis groups, which the highest continuity in the AMI group and lowest in patients with atrial fibrillation. In patients hospitalized due to AMI (n=355, mean age 71 (± 11), 70% men), continuity of care was related to higher perceived control, higher quality of life, a good financial situation, being a man, no symptoms of anxiety or depression (ᚹ range 0.17–0.26 p≤0.002). A low score on the PCCQ were associated with follow-up visit to a nurse in primary care after hospitalization (ᚹ −0.12 p=0.033). In patients hospitalized due to angina (n=210, mean age 73 (± 9), 74% men), continuity of care was related to higher perceived control, higher quality of life and no depressive symptoms (ᚹ range between 0.20 and 0.26 p=0.005). In patients with AF, (n=255, mean age 71 (± 10.), 58% men), continuity of care was related to having had contact by telephone with a nurse-led AF clinic, higher perceived control, higher quality of life and not being depressed (ᚹ range between 0.14–0.25 p=0.03). In patients with HF, (n=173, mean age 77 (±8) 59% men), continuity was related to male ender, younger age, follow-up in a nurse-led HF clinic and not being anxious (ᚹ range between 0.16 and 0.22 p=0.004–0.047). Low total score on PCCQ correlated to having had telephone contact with nurse in primary care (ᚹ −0.24 p=0.002). Conclusion Almost half of all patient reported insufficient continuity of care. Perceived control, quality of life, and symptoms of depression were related to higher continuity of care in all diagnose groups except heart failure. Further, there was a correlation between continuity and follow-up visits or contact by telephone with nurse-led clinics in all diagnose groups except angina. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Medical Research Council of Southeast Sweden, Centre for Clinical Research Sörmland

scholarly journals Quality of life, diagnosis, and treatment of patients with major depression: a prospective cohort study in primary care

2011 ◽  
Vol 33 (3) ◽  
pp. 245-251 ◽  
Author(s):  
Ana Flávia Barros da Silva Lima ◽  
Marcelo Pio de Almeida Fleck
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Cohort Study ◽  
Major Depression ◽  
Antidepressant Treatment ◽  
Epidemiologic Studies ◽  
World Health ◽  
World Health Organization Quality

OBJECTIVE: To describe the demographic and clinical characteristics, adequacy of antidepressant treatment, and changes in quality of life of patients with major depression receiving follow-up care from primary care centers. METHOD: A cohort study was performed in which major depression patients were followed-up over a nine-month period. Several evaluation instruments were used, including the World Health Organization Quality of Life and the Quality of Life-Depression, Centers for Epidemiologic Studies-Depression questionnaires. RESULTS: The sample comprised 179 individuals, mostly female (73%), with a mean age of 38 years and mean education of 9 years. At the end of the follow-up period, 42% of the individuals still presented with major depression, 25% had complete symptom remission, and only 9% were properly treated with antidepressants. In relation to quality of life, there were significant differences especially between baseline and after nine months in almost all measures. CONCLUSION: This study demonstrated that depressive symptoms are poorly recognized and that treatment is often inadequate for patients followed-up in primary care units in the south of Brazil. Most of the patients continued to have symptoms of depression over the nine-month period which were associated with impaired quality of life.

scholarly journals A Children’s Asthma Education Program: Roaring Adventures of Puff (RAP), Improves Quality of Life

2010 ◽  
Vol 17 (2) ◽  
pp. 67-73 ◽  
Author(s):  
Shawna L McGhan ◽  
Eric Wong ◽  
Heather M Sharpe ◽  
Patrick A Hessel ◽  
Puish Mandhane ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Usual Care ◽  
Education Program ◽  
Intervention Group ◽  
Asthma Management ◽  
Control Group ◽  
Asthma Education ◽  
Children With Asthma

BACKGROUND: It is postulated that children with asthma who receive an interactive, comprehensive education program would improve their quality of life, asthma management and asthma control compared with children receiving usual care.OBJECTIVE: To assess the feasibility and impact of ‘Roaring Adventures of Puff’ (RAP), a six-week childhood asthma education program administered by health professionals in schools.METHODS: Thirty-four schools from three health regions in Alberta were randomly assigned to receive either the RAP asthma program (intervention group) or usual care (control group). Baseline measurements from parent and child were taken before the intervention, and at six and 12 months.RESULTS: The intervention group had more smoke exposure at baseline. Participants lost to follow-up had more asthma symptoms. Improvements were significantly greater in the RAP intervention group from baseline to six months than in the control group in terms of parent’s perceived understanding and ability to cope with and control asthma, and overall quality of life (P<0.05). On follow-up, doctor visits were reduced in the control group.CONCLUSION: A multilevel, comprehensive, school-based asthma program is feasible, and modestly improved asthma management and quality of life outcomes. An interactive group education program offered to children with asthma at their school has merit as a practical, cost-effective, peer-supportive approach to improve health outcomes.

scholarly journals Evaluation of asthma control, parents’ quality of life and preference between AeroChamber Plus and AeroChamber Plus Flow-Vu spacers in young children with asthma

2014 ◽  
Vol 52 (3) ◽  
pp. 301-307 ◽  
Author(s):  
Wesam G. Ammari ◽  
Sophie Toor ◽  
Philip Chetcuti ◽  
John Stephenson ◽  
Henry Chrystyn
Keyword(s):  
Quality Of Life ◽  
Young Children ◽  
Asthma Control ◽  
Children With Asthma

scholarly journals Major depression and its correlates in primary care settings in six countries

2005 ◽  
Vol 186 (1) ◽  
pp. 41-47 ◽  
Author(s):  
Marcelo Pio De Almeida Fleck ◽  
Gregory Simon ◽  
Helen Herrman ◽  
Donald Bushnell ◽  
Mona Martin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Logistic Regression ◽  
Major Depression ◽  
Complete Remission ◽  
Life Events ◽  
Scale Score ◽  
Depression Scale

BackgroundFew published studies address depression outcomes in primary care from a cross-cultural perspective.AimsTo define baseline factors associated with 9-month clinical outcome: across six countries.MethodAdults meeting criteria for current major depression were recruited from primary care clinics in Australia, Brazil, Israel, Spain, Russia and the USA; 968 patients were assessed at the 9-month follow-up. Predictors of complete remission were examined using logistic regression with a hierarchical model.ResultsRates of complete remission in the six sites ranged from 25% to 48%. Logistic regression using pooled data showed that education, key life events and the Quality of Life Depression Scale score at baseline were the final predictors of complete remission, adjusting for centres, socio-demographic data, severity of depression, comorbidity and general quality of life. Variation in predictors across sites was not statistically significant.ConclusionsThe two major findings of this study were the low proportion of people achieving complete remission at follow-up across the six sites, and that some baseline characteristics (education, Quality of Life Depression Scale score and key life events) are modest predictors of outcome in depression.

Impact of Race on Quality of Life of Families of Children With Asthma When Asthma Guidelines Are Followed: Long-Term Follow-Up

CHEST Journal ◽  
2017 ◽  
Vol 152 (4) ◽  
pp. A846
Author(s):  
Shahid Sheikh ◽  
Judy Pitts ◽  
Mehek Sheikh ◽  
Nancy Ryan-Wenger
Keyword(s):  
Quality Of Life ◽  
Children With Asthma ◽  
Long Term Follow Up

scholarly journals A single Epley manoeuvre can improve self-perceptions of disability (quality of life) in patients with cp-BPPV: A randomised controlled trial in primary care.

2020 ◽  
Author(s):  
Ricard Carrillo Muñoz ◽  
Jose Luis Ballve Moreno ◽  
Ivan Villar Balboa ◽  
Yolanda Rando Matos ◽  
Oriol Cunillera Puertolas ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Intervention Group ◽  
Control Group ◽  
Perceived Disability ◽  
Self Perceptions ◽  
Perceptions Of Disability ◽  
The Impact

Abstract Background: Posterior canal benign paroxysmal positional vertigo (pc-BPPV) causes physical, functional, and emotional impairment. The treatment of choice is the Epley manoeuvre (EM). The purpose of the study was to compare the impact of the EM and a sham manoeuvre in primary care on self-perceived disability. Method: Randomised, double-blind, sham-controlled clinical trial conducted in primary care with a follow-up of 1 year. Patients aged ≥18 years old diagnosed with pc-BPPV according to the Dix-Hallpike test (DHT) were randomised to an intervention (EM) group or a control (sham manoeuvre) group. The main study covariables were age, sex, history of depression and anxiety, presence of nystagmus in the DHT, patient-perceived disability assessed with the Dizziness Handicap Inventory-screening version (DHI-S). Data were analyzed using bivariate and multivariate mixed Tobit analyses. Results: Overall, 134 patients were studied: 66 in the intervention group and 68 in the control group. Median age was 52 years (interquartile range [IQR], 38.25–68.00 years) and 76.12% of the patients were women. The DHT triggered nystagmus in 40.30% of patients. The median total DHI-S score for the overall sample at baseline was 16 (IQR, 8.00–22.00); 16 [IQR, 10.5–24.0] vs 10 [6.0–14.0] for women vs men ( P <0.001) and 16 [IQR, 10.0-24.0] vs 12 [IQR, 8.0–18.0] for patients without nystagmus vs those with nystagmus ( P =0.033).Patients treated with the EM experienced a mean reduction of 2.03 points in DHI-S score over the follow-up period compared with patients in the sham group. Conclusion: Pc-BPPV affects the quality of life of primary care patients. A single EM can improve self-perceptions of disability by around 2 points on the DHI-S scale, Trial registration : ClinicalTrials.gov Identifier: NCT01969513. Retrospectively registered. First Posted: October 25, 2013. https://clinicaltrials.gov/ct2/show/NCT01969513

Quality of life and asthma control in elderly asthmatics: A seven year follow-up – Results from the PRAXIS study

2016 ◽  
Author(s):  
Björn Ställberg ◽  
Joyce Hogebrug ◽  
Christer Janson ◽  
Mary Kämpe ◽  
Scott Montgomery ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Asthma Control ◽  
Elderly Asthmatics

scholarly journals The Use of Telemedicine Access to Schools to Facilitate Expert Assessment of Children with Asthma

2008 ◽  
Vol 2008 ◽  
pp. 1-7 ◽  
Author(s):  
David A. Bergman ◽  
Paul J. Sharek ◽  
Kathryn Ekegren ◽  
Shannon Thyne ◽  
Michelle Mayer ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Physician ◽  
Expert Assessment ◽  
Asthma Care ◽  
School Based ◽  
Follow Up Care ◽  
Children With Asthma ◽  
Asthma Outcomes ◽  
Improve Access

Research has shown that access to an asthma specialist improves asthma outcomes. We hypothesized that we could improve access to expert asthma care through a telemedicine link between an asthma specialist and a school-based asthma program. We conducted a prospective cohort study in 3 urban schools to ascertain the feasibility of using an asthma-focused telemedicine solution. Each subject was seen by an asthma expert at 0, 8, and 32 weeks. The assessment and recommendations for care were sent to the primary care physician (PCP) and parents were told to contact their physician for follow-up care. Eighty three subjects participated in the study. Subjects experienced improvement (P<.05) in family social activities and the number of asthma attacks. Ninety four percent of subjects rated the program as good or excellent. This study demonstrates the feasibility and acceptance of a school-based asthma program using a telemedicine link to an asthma specialist.

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