scholarly journals Improving access to primary care: a mixed-methods approach studying a new review appointment system in a Scottish GP practice

2021 ◽  
Vol 10 (2) ◽  
pp. e001279
Author(s):  
Jay Slater ◽  
Salahuddin Malik ◽  
Peter Davey ◽  
Suzanne Grant
Keyword(s):  
Mixed Methods ◽  
Participant Observation ◽  
Administrative Staff ◽  
Post Intervention ◽  
Mixed Methods Approach ◽  
Number Of Patients ◽  
Appointment System ◽  
The Impact ◽  
Staff Workload ◽  
Improvement Intervention

A Scottish general practitioner (GP) practice proposed an improvement intervention, shorter pre-bookable ‘review’ appointments, to increase appointment capacity and meet their patients’ demand for appointments. Staff are now able to pre-book these review appointments for patients, guaranteeing that the patient will see the same GP or advanced nurse practitioner (ANP) for both initial and review appointments. By shortening the review appointments, more patients were seen each day, hence the appointment capacity increased. The aim of this project was to examine the impact of the improvement intervention, pre-bookable review appointments, using a mixed-methods approach. Ethnographic methods (non-participant observation, participant observation and eight semistructured interviews with administrative staff) provided qualitative data, to understand the appointment system and to identify areas for further improvement. Quantitative data were then collected to assess: the number of patients receiving ‘on the day’ appointments, with the aim for this to be 95% (outcome measure); by how much the number of appointments available had increased (process measure) and the administrative staff workload (balancing measure). During a 7-week period, 3 months post-intervention, a median of 93% of patients received an ‘on the day’ appointment when they phoned for one between 08:00 and 09:00. The number of appointments available increased by 43%. Administrative staff workload (number of calls received per day) remained the same. Patients prefer being able to book in to see the same GP (continuity of care) and the ability to book in advance. Administrative staff workload decreased in terms of dealing with less frustrated patients. Main suggestions for improvement include introducing later appointments for workers and text reminders for pre-booked (review and online) appointments. The introduction of pre-bookable review appointments improved patient accessibility in the practice. Next steps for improving the appointment system include gaining clinician (GP/ANP) opinions on review appointments and trialling later appointments.

The impact of an education intervention on the approach of hospital staff to patients with dementia in a Danish general hospital setting: An explanatory sequential mixed-methods study

2021 ◽  
pp. 205715852110229
Author(s):  
Annemarie Toubøl ◽  
Lene Moestrup ◽  
Katja Thomsen ◽  
Jesper Ryg ◽  
Dennis Lund Hansen ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Data Collection ◽  
General Hospital ◽  
Hospital Staff ◽  
Education Intervention ◽  
Post Intervention ◽  
Sequential Mixed Methods ◽  
Number Of Patients ◽  
The Impact ◽  
Dementia Education

The number of patients with dementia admitted to hospitals is increasing. However, the care and treatment of these patients tends to be suboptimal. A response to this is a widespread implementation of educational initiatives. Nevertheless, the effect of such initiatives is questioned. The aim of this study was to investigate the impact of a dementia education intervention by examining the self-reported outcomes of general hospital staff and exploring the staff’s experiences of these outcomes. An explanatory sequential mixed-methods design framed the study method. The quantitative data collection included repeated questionnaires: pre-intervention ( n = 849), one month post-intervention ( n = 618), and five months post-intervention ( n = 468) followed by a qualitative data collection using interviews ( n = 16). The GRAMMS guideline was followed. The integration of the quantitative and qualitative results suggests that the impact of the education intervention can be ascribed to the interdisciplinary focus, which facilitated a comprehensive commitment to creating careful solutions for patients with dementia. A prioritization of person over task seems to be assisted by an improved interdisciplinary cooperation initiated by the inclusion of all employed staff at the hospital in a dementia education intervention.

scholarly journals The potential for person-centred planning to support the community participation of adults with an intellectual disability

2021 ◽  
pp. 174462952110221
Author(s):  
Darren McCausland ◽  
Esther Murphy ◽  
Mary McCarron ◽  
Philip McCallion
Keyword(s):  
Intellectual Disability ◽  
Mixed Methods ◽  
Community Participation ◽  
Social Inclusion ◽  
Mixed Methods Approach ◽  
Complex Needs ◽  
Qualitative Case Studies ◽  
Quantitative Analyses ◽  
The Right ◽  
The Impact

Person-centred planning (PCP) puts individuals with an intellectual disability at the centre of service and support planning, identifying how individuals wish to live their lives and what is needed to make that possible. PCP has been identified as having the potential to facilitate improved social inclusion and community participation. A mixed-methods approach combined quantitative analyses with qualitative case studies of individuals with severe-profound intellectual disability to assess the impact of PCP on community participation for adults with an intellectual disability at a disability service in Dublin. We conclude that PCP may provide a good basis to plan community participation and, with the right supports in place, may provide opportunities for people with complex needs to improve their community participation. Supports including familiar staff and family are critical to the success of PCP for people with complex needs, and their absence may undermine the best intentions of PCP for this population.

Feasibility of a Lifestyle Physical Activity Intervention to Prevent Memory Loss in Older Women With Cardiovascular Disease: A Mixed-Methods Approach

2019 ◽  
pp. 084456211985623 ◽  
Author(s):  
Shannon Halloway ◽  
JoEllen Wilbur ◽  
Michael E. Schoeny ◽  
Lynne T. Braun ◽  
Neelum T. Aggarwal ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cardiovascular Disease ◽  
Mixed Methods ◽  
Physical Activity Intervention ◽  
Memory Loss ◽  
Post Intervention ◽  
Mixed Methods Approach ◽  
High Satisfaction ◽  
Post Test ◽  
Lifestyle Physical Activity

Background Memory loss in older age affects women more than men and cardiovascular disease is a leading risk factor. Physical activity can improve memory in healthy older adults; however, few physical activity interventions have targeted women with cardiovascular disease, and none utilized lifestyle approaches. Purpose The purpose of this study was to examine feasibility, acceptability, and preliminary effects of a 24-week lifestyle physical activity intervention (physical activity prescription, five group meetings, and nine motivational interviewing calls). Methods A sequential mixed-methods approach was used. Participants were 18 sedentary women ≥65 years with cardiovascular disease and without cognitive impairment recruited in August 2017. Feasibility, acceptability, self-reported health, accelerometer-assessed physical activity, and neurocognitive memory tests were measured using a pre-post test design. Two post-intervention focus groups ( n = 8) were conducted in June 2018. Concept analysis was used to identify barriers/motivators of intervention participation. Results Meeting attendance was >72% and retention was 94%. Participants rated the program with high satisfaction. There were significant improvements at 24 weeks in self-rated physical health, objective daily steps, and estimated cardiorespiratory fitness ( d = .30–.64). Focus group themes generated recommendations for modifying the intervention. Conclusion Findings support adapting the intervention further for women with cardiovascular disease and testing it in an efficacy trial.

scholarly journals Applying quality improvement principles to improve accident and emergency department overcrowding and flow in Rwanda: a case study

2015 ◽  
Vol 4 (5) ◽  
pp. 47 ◽  
Author(s):  
Jean Claude Byiringiro ◽  
Rex Wong ◽  
Caroline Davis ◽  
Jeffery Williams ◽  
Joseph Becker ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Success Factors ◽  
Low Cost ◽  
Post Intervention ◽  
Triage System ◽  
Accident And Emergency ◽  
Number Of Patients ◽  
Accident And Emergency Department ◽  
The Impact

Few case studies exist related to hospital accident and emergency department (A&E) quality improvement efforts in lowerresourced settings. We sought to report the impact of quality improvement principles applied to A&E overcrowding and flow in the largest referral and teaching hospital in Rwanda. A pre- and post-intervention study was conducted. A linked set of strategies included reallocating room space based on patient/visitor demand and flow, redirecting traffic, establishing a patient triage system and installing white boards to facilitate communication. Two months post-implementation, the average number of patients boarding in the A&E hallways significantly decreased from 28 (pre-intervention) to zero (post-intervention), p < .001. Foot traffic per dayshift hour significantly decreased from 221 people to 160 people (28%, p < .001), and non-A&E related foot traffic decreased from 81.4% to 36.3% (45% decrease, p < .001). One hundred percent of the A&E patients have been formally triaged since the implementation of the newly established triage system. Our project used quality improvement principles to reduce the number of patients boarding in the hallways and to decrease unnecessary foot traffic in the A&E department with little investment from the hospital. Key success factors included a collaborative multidisciplinary project team, strong internal champions, data-driven analysis, evidence-based interventions, senior leadership support, and rapid application of initial implementation learnings. Results to date show the application of quality improvement principles can help hospitals in resource-limited settings improve quality of care at relatively low cost.

The Impact of Implementing a “Pain, Agitation, and Delirium Bundle” in a Pediatric Intensive Care Unit: Improved Delirium Diagnosis

2021 ◽  
Author(s):  
Lise D. Cloedt ◽  
Kenza Benbouzid ◽  
Annie Lavoie ◽  
Marie-Élaine Metras ◽  
Marie-Christine Lavoie ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Post Intervention ◽  
Number Of Patients ◽  
Implementation Period ◽  
Short And Long Term ◽  
The Impact

AbstractDelirium is associated with significant negative outcomes, yet it remains underdiagnosed in children. We describe the impact of implementing a pain, agitation, and delirium (PAD) bundle on the rate of delirium detection in a pediatric intensive care unit (PICU). This represents a single-center, pre-/post-intervention retrospective and prospective cohort study. The study was conducted at a PICU in a quaternary university-affiliated pediatric hospital. All patients consecutively admitted to the PICU in October and November 2017 and 2018. Purpose of the study was describe the impact of the implementation of a PAD bundle. The rate of delirium detection and the utilization of sedative and analgesics in the pre- and post-implementation phases were measured. A total of 176 and 138 patients were admitted during the pre- and post-implementation phases, respectively. Of them, 7 (4%) and 44 (31.9%) were diagnosed with delirium (p < 0.001). Delirium was diagnosed in the first 48 hours of PICU admission and lasted for a median of 2 days (interquartile range [IQR]: 2–4). Delirium diagnosis was higher in patients receiving invasive ventilation (p < 0.001). Compliance with the PAD bundle scoring was 79% for the delirium scale. Score results were discussed during medical rounds for 68% of the patients in the post-implementation period. The number of patients who received opioids and benzodiazepines and the cumulative doses were not statistically different between the two cohorts. More patients received dexmedetomidine and the cumulative daily dose was higher in the post-implementation period (p < 0.001). The implementation of a PAD bundle in a PICU was associated with an increased recognition of delirium diagnosis. Further studies are needed to evaluate the impact of this increased diagnostic rate on short- and long-term outcomes.

Developing a Gameful Approach as a Tool for Innovation and Teaching Quality in Higher Education

2022 ◽  
pp. 563-578
Author(s):  
Anna Sendra ◽  
Natàlia Lozano-Monterrubio ◽  
Jordi Prades-Tena ◽  
Juan Luis Gonzalo-Iglesia
Keyword(s):  
Higher Education ◽  
Mixed Methods ◽  
Learning Process ◽  
Participant Observation ◽  
Learning Experience ◽  
Teaching Quality ◽  
Working Practices ◽  
Quality In Higher Education ◽  
The Impact

This paper introduces the results of applying a gameful approach based on six playful activities as a tool to improve the learning process in higher education. A total of 850 students from different courses of Universitat Rovira i Virgili (Spain) were involved in the study. The strategy was evaluated through a participant observation (active and passive) and mixed-methods surveys answered by the students. Results point out that most participants responded positively to the activities proposed. The reported levels of motivation and engagement also indicate the capabilities of this strategy as a method to enhance the learning experience of students. Despite these positive outcomes, challenges like the impact on working practices of teachers or the long-term engagement of gameful approaches requires additional research.

Separatist Threat, Militarization and Voter Turnout: Exploring the Dynamics of the 2017 Governorship Election in Anambra State, Nigeria

2020 ◽  
Vol 55 (8) ◽  
pp. 1093-1107
Author(s):  
Peter O. Mbah ◽  
Thaddeus C. Nzeadibe ◽  
Chikodiri Nwangwu ◽  
Ambrose O. Iheanacho ◽  
Christopher Okonkwo Eze ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Voter Turnout ◽  
Political Development ◽  
State Building ◽  
The State ◽  
Mixed Methods Approach ◽  
Anambra State ◽  
Political Exclusion ◽  
The Impact

Using the qual-dominant mixed methods approach, this study analysed the impact of the separatist threat and the militarization of elections on voter turnout during the 2017 governorship election in Anambra State, Nigeria. Findings indicate that perceived and real marginalization of the Igbo in Nigeria’s state-building is largely driving the neo-Biafra separatist threat to boycott elections in Anambra State. This does not only account for the state militarization of elections in order to guarantee security; it also inadvertently engendered fear among citizens, undermined voter turnout and exacerbated political exclusion. This study concludes that inclusive political development presents an opportunity for de-escalation of separatist threats, demilitarization of elections and enhancement of voter turnout in Nigeria.

scholarly journals Assessment of Reflex Urine Culture Criteria Changes and its Impact on Treatment of Asymptomatic Bacteriuria

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S346-S346 ◽  
Author(s):  
Kirre Wold ◽  
Jeff Brock ◽  
Kelly Percival ◽  
Lindsey Rearigh ◽  
Lucas Vocelka ◽  
...  
Keyword(s):  
Asymptomatic Bacteriuria ◽  
Signs And Symptoms ◽  
Hospital Data ◽  
Post Intervention ◽  
Number Of Patients ◽  
Positive Urine ◽  
Before And After ◽  
Implementation Period ◽  
Inappropriate Antibiotics ◽  
The Impact

Abstract Background Asymptomatic bacteriuria (ASB) is a common clinical condition identified by the presence of bacteria in the urine of a patient without signs and symptoms of a urinary tract infection (UTI). Treatment of ASB leads to unnecessary antimicrobial use and can cause more harm than benefit in many patients. This study is to determine the impact of more stringent criteria for urinalysis with culture if indicated (UAC), implemented in September 2016, on the treatment of asymptomatic bacteriuria. Methods A pre-post descriptive study of patients was conducted with an order placed for UAC in the Emergency Department (ED) or hospital. Data was collected retrospectively via chart reviews. The data on ASB patients from November 2015 to April 2016 was compared with the post-implementation period October 2016 to January 2017. The number of UAC orders and cultures were averaged for 6 months pre and post implementation of the criteria change. Results A total of 580 patient charts were assessed post-implementation of the UAC criteria change. A majority of the orders originated from the ED, (N = 430, 72.8%). ASB was treated inappropriately at a rate of 60.4% (N = 64/106) pre-implementation and a rate of 65% (N = 41/63) post implementation, P = 0.542. The total number of UAC ordered before and after implementation did not change, (N = 2852 pre-intervention vs N = 2825 post-intervention, P = 0.744), as seen in Figure 1. However, the number of reflexed urine cultures did significantly decrease post criteria change,&#x2028; (N = 1056 pre-intervention vs. N = 603 post-intervention, P &lt; 0.0001). In addition, the number of positive urine cultures also significantly decreased, (N = 378 pre-intervention vs. N = 289 post-intervention, P = 0.0447). The impact the criteria change had on patient care is the number of potential antibiotic courses saved by reflexing fewer urine cultures off the UAC. Based on the decrease in positive urine cultures, it is estimated 702 courses of inappropriate antibiotics for ASB could be saved per year (59/month). Conclusion More stringent criteria for reflex urine cultures significantly decreases the number of urine cultures performed, therefore decreasing the number of patients treated with ASB. Additional stewardship measures are necessary to reduce the treatment of ASB for patients who have cultures performed. Disclosures All authors: No reported disclosures.

scholarly journals Engaging customers through user-and company-generated content on CSR

2019 ◽  
Vol 23 (3) ◽  
pp. 339-372 ◽  
Author(s):  
Alberto Badenes-Rocha ◽  
Carla Ruiz-Mafé ◽  
Enrique Bigné
Keyword(s):  
Social Media ◽  
Mixed Methods ◽  
Hotel Industry ◽  
User Generated Content ◽  
Customer Engagement ◽  
Content Type ◽  
Mixed Methods Approach ◽  
Customer Perceptions ◽  
Customer Trust ◽  
The Impact

Purpose This study aims to analyze the role of corporate social responsibility (CSR) customer perceptions, customer–company identification and customer trust on customer engagement (CE), paying special attention to the moderating effects of two types of social media communication, firm-generated content and user-generated content. Design/methodology/approach The study uses a mixed-methods’ approach. First, a single-factor experiment using Twitter posts as stimuli with 227 hotel guests. The structural model was analyzed using SmartPLS 3.2.7. Second, structured in-depth interviews were undertaken with three hotel industry experts to complement the conclusions of the quantitative study. Findings The results show that when a customer trusts a hotel and identifies with its corporate values, CSR tweets generate CE toward the hotel. CSR communications made by customers reinforce the impact of CSR tweets on customer trust more than CSR tweets posted by hotels. Hotel industry experts give insights to explain these results in different types of hotels. Practical implications CSR communications made through Twitter affect customers’ perceptions of a hotel’s CSR activities and customer trust in hotels, especially if they originate from a source external to the company. This result can be of use for hotel managers who have not previously given importance to active CSR communications or the interactivity of social media. Originality/value The authors show the moderating effect of user-generated content in the relationship between CSR customer perceptions and customer trust, thus contributing to the research into the effectiveness of social media. They use a mixed-methods’ approach to increase the validity of the results.

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