scholarly journals Health workers’ perspectives on asthma care coordination between primary and specialised healthcare in the COVID-19 pandemic: a protocol for a qualitative study in Ecuador and Brazil

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e052971
Author(s):  
Natalia Cristina Romero ◽  
Maria Jose Cisneros-Caceres ◽  
Emily Granadillo ◽  
Erika Aragao ◽  
Adriana Romero-Sandoval ◽  
...  
Keyword(s):  
Asthma Control ◽  
Narrative Analysis ◽  
Care Coordination ◽  
Health Workers ◽  
Clinical Information ◽  
Ethics Committees ◽  
Limited Information ◽  
Asthma Care ◽  
Healthcare Data ◽  
Data Saturation

IntroductionAsthma is a common long-term disorder and strategies to improve asthma control are still a challenge. Integrated delivery of health systems is critical for effective asthma care: there is limited information on experiences of care coordination for asthma from Latin America, especially on perspectives of health personnel and in the context of the COVID-19 pandemic.Methods and analysisThis protocol details a qualitative approach to analyse health workers’ perspectives of healthcare coordination for asthma control during COVID-19 pandemic in Ecuador and Brazil, at primary and specialised levels, through in-depth semistructured interviews using a video communications platform. The analysis will identify knowledge and perspectives based on coordination of clinical information, clinical management and administrative coordination. Theoretical sampling will be used to obtain approximately equal numbers of women and men within each level of healthcare; data saturation will be used to determine sample size. Transcripts will be analysed using content-coding procedures to mark quotations related to major topics and subthemes included in the interview guide, and narrative analysis will be based on a theoretical framework for healthcare coordination to identify new themes and subthemes.Ethics and disseminationEthical approval was obtained from the ethics committees of Hospital General Docente Calderón, Quito, Ecuador; and Universidade Federal da Bahia, Salvador, Brazil. The findings of this study will be disseminated through peer-reviewed articles, conference presentations and condensed summaries for key stakeholders and partners.

scholarly journals A Heuristic Evaluation to Assess Use of After Visit Summaries for Supporting Continuity of Care

2018 ◽  
Vol 09 (03) ◽  
pp. 714-724 ◽  
Author(s):  
Patrice Tremoulet ◽  
Ramya Krishnan ◽  
Dean Karavite ◽  
Naveen Muthu ◽  
Susan Regli ◽  
...  
Keyword(s):  
Care Coordination ◽  
Clinical Information ◽  
Heuristic Evaluation ◽  
Care Providers ◽  
Evaluation Instrument ◽  
Structural Problems ◽  
Usability Problems ◽  
New Instrument ◽  
Medical Documents

Background Outpatient providers often do not receive discharge summaries from acute care providers prior to follow-up visits. These outpatient providers may use the after-visit summaries (AVS) that are given to patients to obtain clinical information. It is unclear how effectively AVS support care coordination between clinicians. Objectives Goals for this effort include: (1) developing usability heuristics that may be applied both for assessment and to guide generation of medical documents in general, (2) conducting a heuristic evaluation to assess the use of AVS for communication between clinicians, and (3) providing recommendations for generating AVS that effectively support both patient/caregiver use and care coordination. Methods We created a 17-item heuristic evaluation instrument for assessing usability of medical documents. Eight experts used the instrument to assess each of four simulated AVS. The simulations were created using examples from two hospitals and two pediatric patient cases developed by the National Institute of Standards and Technology. Results Experts identified 224 unique usability problems ranging in severity from mild to catastrophic. Content issues (e.g., missing medical history, marital status of a 2-year-old) were rated as most severe, but widespread formatting and structural problems (e.g., inconsistent indentation, fonts, and headings; confusing ordering of information) were so distracting that they significantly reduced readers' ability to efficiently use the documents. Overall, issues in the AVS from Hospital 2 were more severe than those in the AVS from Hospital 1. Conclusion The new instrument allowed for quick, inexpensive evaluations of AVS. Usability issues such as unnecessary information, poor organization, missing information, and inconsistent formatting make it hard for patients, caregivers, and clinicians to use the AVS. The heuristics in the new instrument may be used as guidance to adapt electronic health record systems so that they generate more useful and usable medical documents.

Care coordination in two of Bogota’s public healthcare networks: A cross-sectional study among doctors

2019 ◽  
Vol 22 (3-4) ◽  
pp. 127-139 ◽  
Author(s):  
Andrés Daniel Gallego-Ardila ◽  
Ángela María Pinzón-Rondón ◽  
Amparo Susana Mogollón-Pérez ◽  
Carol Ximena Cardozo ◽  
Ingrid Vargas ◽  
...  
Keyword(s):  
Job Satisfaction ◽  
Care Coordination ◽  
Clinical Management ◽  
Waiting Times ◽  
Clinical Information ◽  
Cross Sectional Study ◽  
Public Healthcare ◽  
Sectional Study ◽  
Cross Sectional ◽  
High Level

Introduction Care coordination is a priority concern for healthcare systems. In Colombia, there is a lack of information on the topic. This study analysed how doctors of two Bogotá’s public healthcare networks perceived coordination between healthcare levels and what factors are associated with their perception. Methods A cross-sectional study using the COORDENA-CO questionnaire to a sample of 363 doctors (network-1 = 181; network-2 = 182) in 2015. The questionnaire asks about types and dimensions of care coordination: information and clinical management, with items in a Likert scale, as well as conditions regarding health system, organisational and doctors’ conditions. Descriptive statistics and logistic regression analysis were performed. Results The doctors’ perception of a high level of coordination did not exceed 25.4%. On coordination of information, limited transfer of clinical information was found. Concerning clinical management, there were limited care coherence, deficits in patient follow-up and lengthy waiting times for specialised care. A high perception of coordination were associated with being female, being over 50 years old, being a specialist, having less than one year’s working experience, working less than 20 h per week at the centre, forming part of network-1, having time available for performing coordination tasks, having job satisfaction and not identifying limitations imposed by healthcare insurers. Discussion There was limited perception of coordination, in its different dimensions and types with some differences between networks. The results support the importance of guaranteeing job satisfaction, ensuring sufficient time to coordination-related activities and intervening in the restrictions imposed by healthcare insurers to improve care coordination.

scholarly journals Asthma knowledge, care, and outcome during pregnancy: The QAKCOP study

2018 ◽  
Vol 16 ◽  
pp. 147997231876771 ◽  
Author(s):  
Wanis H Ibrahim ◽  
Fatima Rasul ◽  
Mushtaq Ahmad ◽  
Abeer S Bajwa ◽  
Laith I Alamlih ◽  
...  
Keyword(s):  
Health Care ◽  
Asthma Control ◽  
Inhaled Corticosteroids ◽  
Medical Condition ◽  
Action Plan ◽  
Well Being ◽  
Chronic Medical Condition ◽  
Uncontrolled Asthma ◽  
Asthma Care ◽  
In Pregnancy

Asthma is the most common chronic medical condition affecting pregnancy. Optimizing asthma management in pregnancy is paramount for the well-being of both the mother and the baby. The primary objectives of this study were to assess patient’s knowledge about asthma, the level of asthma care, and fetal and maternal outcomes among pregnant asthmatic women in this wealthy country with tremendous improvement in maternal and fetal health care. The secondary objective was to identify barriers to asthma control. This was a cross-sectional, face-to-face, prospective study of 80 pregnant women with physician-diagnosed asthma. About 56% of patients reported worsening of their asthma control during pregnancy, of which 52.3% felt this worsening in the third trimester. About 65% of patients had uncontrolled asthma during their pregnancy, and inhaler technique was incorrect in 64.4%. Only 38% of patients knew the difference between controller and reliever asthma medications, 12.7% of patients had received written asthma action plan, 17% had a spirometry done in the previous 5 years, and 3.8% had peak expiratory flow meter at home. The main reasons for uncontrolled asthma were lack of knowledge about right asthma medications in 30% and fear of side effects of inhaled corticosteroids in 19% of patients. No financial reason was reported. Significant associations between total number of pregnancies, poor perception of asthma medications, asthma exacerbation during delivery and poor asthma control were observed. Preeclampsia and congenital anomalies occurred at higher rates than previously reported among general population in this country. The tremendous improvements in maternal health care and socioeconomic status do not seem to be a barrier to the globally recognized poor asthma care in pregnancy. Important strategies are much needed.

Epidemiology and clinics of mushroom poisoning in Northern Italy: A 21-year retrospective analysis

2017 ◽  
Vol 37 (7) ◽  
pp. 697-703 ◽  
Author(s):  
G Cervellin ◽  
I Comelli ◽  
G Rastelli ◽  
F Sanchis-Gomar ◽  
F Negri ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Early Identification ◽  
Clinical Presentation ◽  
Clinical Course ◽  
Clinical Information ◽  
Northern Italy ◽  
Gastrointestinal Toxicity ◽  
Mushroom Poisoning ◽  
Limited Information ◽  
Life Threatening

Background: Limited information exists about epidemiology and management of mushroom poisoning. We analyzed and described epidemiology, clinical presentation, and clinical course of mushroom-poisoned patients admitted to emergency departments (EDs) of the Province of Parma, Italy. Methods: Data from the database of mycological service were matched with clinical information retrieved from hospitals’ database, from January 1, 1996 to December 31, 2016. Results: Mycologist consultation was obtained in 379/443 identified mushroom poisonings. A remarkable seasonality was found, with significant peak in autumn. Thanks to the collaboration, the implicated species could be identified in 397 cases (89.6%); 108 cases (24.4%) were due to edible mushrooms, Boletus edulis being the most represented (63 cases). Overall, 408 (92%) cases presented with gastrointestinal toxicity. Twenty cases of amatoxin poisoning were recorded (11 Amanita phalloides and 9 Lepiota brunneoincarnata). One liver transplantation was needed. We observed 13 cases of cholinergic toxicity and 2 cases of hallucinogenic toxicity. Finally, 46 cases were due to “mixed” toxicities, and a total of 69 needed hospitalization. Conclusions: Early identification and management of potentially life-threatening cases is challenging in the ED, so that a mycologist service on call is highly advisable, especially during periods characterized by the highest incidence of poisoning.

scholarly journals Cost-Effective Care Coordination for People With Dementia at Home

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Amber Willink ◽  
Karen Davis ◽  
Deirdre M Johnston ◽  
Betty Black ◽  
Melissa Reuland ◽  
...  
Keyword(s):  
Community Health ◽  
Care Coordination ◽  
Care Management ◽  
Comparison Group ◽  
Health Workers ◽  
Cost Effective ◽  
People With Dementia ◽  
Home Intervention ◽  
Matched Comparison ◽  
At Home

Abstract Background and Objectives People with dementia (PWD) represent some of the highest-need and highest-cost individuals living in the community. Maximizing Independence (MIND) at Home is a potentially cost-effective and scalable home-based dementia care coordination program that uses trained, nonclinical community workers as the primary contact between the PWD and their care partner, supported by a multidisciplinary clinical team with expertise in dementia care. Research Design and Methods Cost of care management services based on actual time spent by care management personnel over first 12 months of MIND at Home intervention was calculated for 342 MIND at Home recipients from Baltimore, Maryland and surrounding areas participating in a Centers for Medicare and Medicaid Services (CMS) funded Health Care Innovation Award demonstration project. Difference-in-differences analysis of claims-based Medicaid spending of 120 dually-eligible MIND at Home participants with their propensity score matched comparison group (n = 360). Results The average cost per enrollee per month was $110, or $1,320 per annum. Medicaid expenditures of dually-eligible participants grew 1.12 percentage points per quarter more slowly than that of the matched comparison group. Most savings came from slower growth in inpatient and long-term nursing home use. Net of the cost of the 5-year MIND at Home intervention, 5-year Medicaid savings are estimated at $7,052 per beneficiary, a 1.12-fold return on investment. Discussion and Implications Managed care plans with the flexibility to engage community health workers could benefit from a low-cost, high-touch intervention to meet the needs of enrollees with dementia. Limitations for using and reimbursing community health workers exist in Medicare fee-for-service, which CMS should address to maximize benefit for PWD.

scholarly journals Obstacles for Iranian rural population to participate in health education programmes: a qualitative study

2019 ◽  
Vol 7 (1) ◽  
pp. e000020 ◽  
Author(s):  
Yousef Hamidzadeh ◽  
Mina Hashemiparast ◽  
Hadi Hassankhani ◽  
Hamid Allahverdipour
Keyword(s):  
Health Education ◽  
Qualitative Study ◽  
Rural Health ◽  
Health Information ◽  
Information Seeking ◽  
Health Workers ◽  
Local Health ◽  
Community Based Education ◽  
Rural Settings ◽  
Data Saturation

ObjectiveTo explore the obstacles of community participation in rural health education programmes from the viewpoints of Iranian rural inhabitants.DesignThis was a qualitative study with conventional content analysis approach which was carried out March to October 2016.SettingData collected using semistructured interviews that were digitally recorded, transcribed and analysed until data saturation. MAXQDA 10 software was used to manage the textual data.ParticipantParticipants were twenty-two seven clients from a rural community in Ardabil, Iran who were receiving health services from health centres.ResultThe main obstacles to participate in health education programmes in rural settings were ‘Lack of trust to the rural health workers’, ‘Adherence to neighbourhood social networks in seeking health information’ and ‘Lack of understanding on the importance of health education’.ConclusionRural health education programmes in Iran are encountered with a variety of obstacles. We need to enhancing mutual trust between the rural health workers and villagers, and developing community-based education programmes to promote health information seeking behaviours among villagers. The finding of this study will be a referential evidence for the qualitative improvement of local health education programmes for rural inhabitants.

Program Implementation Approaches to Build and Sustain Health Care Coordination for Type 2 Diabetes

2016 ◽  
Vol 18 (2) ◽  
pp. 306-313 ◽  
Author(s):  
Tania M. Fitzgerald ◽  
Pam A. Williams ◽  
Julia A. Dodge ◽  
Martha Quinn ◽  
Christina L. Heminger ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Health Care ◽  
Care Coordination ◽  
Program Implementation ◽  
Health Workers ◽  
Implementation Strategies ◽  
Framework Analysis ◽  
Health Care Environment ◽  
Quality Health Care

Background: As more people enter the U.S. health care system under the Affordable Care Act (ACA), it is increasingly critical to deliver coordinated, high-quality health care. The ACA supports implementation and sustainability of efficient health care models, given expected limits in available resources. This article highlights implementation strategies to build and sustain care coordination, particularly ones consistent with and reinforced by the ACA. It focuses on disease self-management programs to improve the health of patients with type 2 diabetes, exemplified by grantees of the Alliance to Reduce Disparities in Diabetes. Method: We conducted interviews with grantee program representatives throughout their 5-year programs and conducted a qualitative framework analysis of data to identify key themes related to care coordination. Results: The most promising care coordination strategies that grantee programs described included establishing clinic–community collaborations, embedding community health workers within care management teams, and sharing electronic data. Establishing provider buy-in was crucial for these strategies to be effective. Discussion: This article adds new insights into strategies promoting effective care coordination. The strategies that grantees implemented throughout the program align with ACA requirements, underscoring their relevance to the changing U.S. health care environment and the likelihood of further support for program sustainability.

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.

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