Abstract WP408: Tacls: Taking Action for Optimal Community and Long Term Stroke Care

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Theresa L Green ◽  
Patrice Lindsay
Keyword(s):  
Health Care ◽  
Acute Stroke ◽  
Health Care Providers ◽  
Stroke Care ◽  
Residential Aged Care ◽  
Stroke Survivors ◽  
Care Providers ◽  
Community Based ◽  
Taking Action

Introduction: In Canada, approximately 12% of acute stroke patients are admitted to long-term care (LTC; or residential aged care) facilities following an acute stroke event. An additional 20-30% of patients are discharged home from hospital with referral for community-based homecare. Training programs for health care providers in these settings is variable and at times inconsistent with best practices. Internationally, focus is now shifting from a predominant inpatient acute care focus, to one encompassing ongoing care and support in the community for people living with stroke. In 2015, an educational resource called Taking Action for Optimal Community & Long Term Stroke Care (TACLS) was launched across Canada to ensure the appropriate knowledge and skills of front line care providers for stroke survivors in community and LTC facilities; the focus of this resource is on rehabilitation and recovery. Methods: The purpose of this interactive session is to introduce the TACLS resource and to engage health professionals in an examination of current international community based rehabilitation and recovery programs. The discussion/workshop will allow participants to examine, compare and contrast components of the TACLS program with programs being developed or offered elsewhere. Results: As health care providers helping stroke survivors live well and longer means investing in the use of best practice tools and resources that fit the local context and organizational practices. Bringing together international opinions and observations around post-stroke community care will allow cross-collaboration and inter-professional networking opportunities that ultimately will benefit patients living with stroke in community based settings. Discussion: As care shifts from hospital to community based settings, the importance of tools available to support stroke survivors in this area of the care continuum is essential. In Canada, utilizing the HSF education resource (TACLS) provides information to support community based health care providers working with people who have had a stroke in helping them achieve optimal outcomes, regain their best level of functioning, and live meaningful lives.

Abstract 3123: Toolkit for Return to Work after Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Paula Gilmore ◽  
John Barry ◽  
Jeff Blanchard ◽  
Shannon Howson ◽  
Martha Korzycki
Keyword(s):  
Health Care ◽  
Return To Work ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Service Providers ◽  
Stroke Care ◽  
Face Validity ◽  
Stroke Survivors ◽  
Care Providers ◽  
Negative Impacts

Background: The Southwestern Ontario (SWO) Stroke Network completed community engagement forums with stroke survivors, their loved ones and community service providers to determine barriers to living fully in the community after stroke. One of the priorities identified in the forums was the need for "return to work" services. Currently, 10 % of stroke survivors are people under the age of 50 and in the prime of their working life. Research indicates that return to work rates after stroke are as low as 7%. However, employment is one of the most important social roles that a person fulfills and not working has negative impacts on one’s overall quality of life, health, finances, social isolation and self-efficacy. Stroke survivors and health care professionals need to be aware of how to navigate the process of return to work after stroke. Purpose: A toolkit of resources has been developed to assist stroke survivors and health care professionals navigate the process of return to work after stroke. Methods: A working group comprised of experts in vocational rehabilitation and stroke care developed a toolkit of resources to educate and assist stroke survivors and health care professionals navigate the complex system of return to work. The resources have undergone an external review by health care professionals and stroke survivors. Results: Resources developed include a self assessment guide. It assesses five critical areas to return to work by evaluating the stroke survivor’s current abilities against the demands of the job and is designed to help focus the individual’s recovery efforts. Algorithms on how to navigate the system of return to work, including how to traverse the system of financial benefits and questions to ask employers and information on community financial supports were developed. A literature review and inventories outlining services for persons with stroke, who are preparing to re-enter the workforce, are part of the toolkit. Health care providers and stroke survivors have confirmed the face to face validity of the resources. Conclusions: Research indicates that stroke survivors should be encouraged to evaluate their potential of returning to work and should receive support from knowledgeable professionals regarding return to work as soon as possible after stroke. This toolkit is intended to support stroke survivors and their health care professionals to navigate the system for a successful return to work. Next steps include the development of a website to assist with return to work.

scholarly journals “We are very individual”: Anticipated effects on stroke survivors of using their person-generated health data (Preprint)

2019 ◽  
Author(s):  
Gerardo Luis Dimaguila ◽  
Frances Batchelor ◽  
Mark Merolli ◽  
Kathleen Gray
Keyword(s):  
Health Care ◽  
Health Services ◽  
Focus Groups ◽  
Health Care Providers ◽  
Digital Health ◽  
Stroke Care ◽  
Health Data ◽  
Stroke Survivors ◽  
Care Providers ◽  
Patient Reported

BACKGROUND Person-generated health data (PGHD) are produced by people when they use health information technologies. People who use PGHD may have changes in their engagement with their own health care, their relationship with their healthcare providers, and their sense of social support and connectedness. Research into evaluating those reported effects however, has not kept up; thus a method for developing patient-reported outcome measures (PROMs) of utilising PGHD, called the PROM-PGHD Development Method, was previously designed and applied to the exemplar case of Kinect-based stroke rehabilitation systems (K-SRS). A key step of the method ensures that the patient’s voice is included. Allowing stroke survivors to participate in the development and evaluation of health services and treatment can inform health care providers on decisions about stroke care, and thereby improve health outcomes. Moreover, eliciting the input of stroke survivors is important because there could be differences in their perspectives and that of their care providers, regarding treatment and management. OBJECTIVE This paper presents the perspectives of stroke survivors and clinicians on the anticipated effects of stroke survivors’ use of PGHD from a poststroke simulated rehabilitation technology. METHODS This study gathered the perspectives of six stroke survivors and five clinicians through three focus groups and three interviews, recruited for convenience. In the stroke survivors’ focus groups, participants were asked to give their perspectives on how using the PGHD from Jintronix may affect their outcomes; while in the clinicians’ focus group, clinicians were asked for their perspectives on how PGHD use may affect the outcomes of stroke survivors. Participants were also asked questions intended to encourage them to comment on the initial items of the PROM-PGHD. Deductive thematic analysis was performed. RESULTS Survivors and clinicians had varying perspectives in three of the six themes presented, and puts emphasis on the importance of allowing stroke survivors to participate in the evaluation of digital health services. However, the potential for tensions to occur between the needs and preferences of patients and their care providers could be reduced through a similar understanding of health treatment goals. This paper has further demonstrated that outcomes of utilising PGHD can be measured. For instance, stroke survivors described that using PGHD could result in positive, negative, and nil effects on their health behaviours. CONCLUSIONS This study is the first to gather and compare the perspectives of stroke survivors and clinicians, in order to develop a PROM-PGHD for a simulated rehabilitation system. The reported PGHD utilisation outcomes would directly inform the development of a PROM-PGHD for K-SRS, of which this paper is a key step. Additionally, they could help inform health care providers on decisions about stroke care. This is particularly relevant in the area of poststroke simulated rehabilitation technologies.

Abstract 2197: Telestroke: Optimizing Access to Emergency Interventions in Acute Stroke Care

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Rayetta Johnson
Keyword(s):  
Quality Improvement ◽  
Acute Stroke ◽  
Health Care Providers ◽  
Positive Impact ◽  
Medical Center ◽  
Stroke Care ◽  
Nurse Specialist ◽  
Care Providers ◽  
Acute Stroke Care ◽  
Evidenced Based

Background and Issues: The burden of stroke in North Carolina is one of the highest in the nation (approximately 28,000 stroke hospitalizations from 2003-2007). The number and high costs of stroke have made it incumbent to improve the numbers of patients receiving effective treatment. There are two major barriers for treatment of acute stroke: time and access. The utilization of telestroke in community hospitals aids in decreasing these barriers by providing immediate access to a stroke neurologist. In order for telestroke to be successful, awareness and education regarding acute stroke care must be provided for health care providers as well as the communities. Thus, the development of a telestroke system requires nursing and medical expertise. The Primary Stroke Center Team at Wake Forest Baptist Medical Center in Winston-Salem, N.C. implemented a telestroke network system (Intouch's Health's RP-7 Robotic system) in January of 2010 to provide 24/7 access to the medical center's acute stroke experts and the latest advancements in stroke interventions. There are eight hospitals in the network at the present time. Methods: Our team identified that many of the network hospital's staff are not experienced in taking care of a stroke patient and that a “roadmap” is useful to guide them in these steps.The stroke nurse specialist developed a quality improvement plan for the network hospitals which included: an evidence-based algorithm for patient care; stroke education, in particular, neurological assessment and tPA administration classes for the ED staff; quarterly meetings to provide outcome and feedback data with each network hospital; stroke awareness events for the community. Mock telestroke consults were also performed prior to “going live” with telestroke for each of the network hospitals. Of utmost importance is the early involvement and education of the EMS system in the respective county of the network hospital. The buy-in of EMS was found to be a key component in the success of the network. Finally, attention to customized quality improvement efforts for each of the facilities are required to accomplish integration into the telestroke network. Results: The data has been analyzed, and thus far, a 24% rate of tPA administration has been seen with our network hospitals (an increase from the 3.6% national average). Comparisons between each of the eight network hospitals' rates of administration of tPA prior to and after joining the network show a trend of increase (10%-40%). The effectiveness of the algorithm has also been explored by analysis of feedback and initial results have shown a positive impact. Conclusion: A combination of improving access to stroke neurologists in conjunction with a focus on improving the level of care via evidenced based stroke care teaching and implementation of algorithms at a network hospital is required for implementing and building a successful telestroke network.

Depression: A Long-Term Illness

1994 ◽  
Vol 165 (S26) ◽  
pp. 9-15 ◽  
Author(s):  
Martin B. Keller
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Maintenance Treatment ◽  
Depressive Disorders ◽  
Care Providers ◽  
Serious Illness ◽  
Antidepressant Treatments ◽  
Continued Education ◽  
Low Levels

The realisation that major depression is often both chronic and recurrent has slowly begun to change the way that depression is diagnosed and treated. In particular, the need for continuation and maintenance treatment is an issue that now deserves increased attention, especially with the availability of new classes of antidepressant treatments, which have excellent efficacy and more favourable side-effect profiles. Although the serious consequences of depressive disorders clearly indicate the need for effective and prompt intervention on the part of clinicians, the results of several studies indicate that patients with depression consistently receive no or low levels of antidepressant therapy. It is hoped that, through continued education of health care providers and patients about the consequences of depression, the issue of undertreatment of this serious illness will be resolved.

scholarly journals “Take the treatment and be brave”: Care experiences of pregnant women with rifampicin-resistant tuberculosis

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0242604
Author(s):  
Marian Loveday ◽  
Sindisiwe Hlangu ◽  
Jennifer Furin
Keyword(s):  
Health Care ◽  
Pregnant Women ◽  
Health Care System ◽  
Health Care Providers ◽  
Physical Symptoms ◽  
Coding System ◽  
Care Providers ◽  
Convenience Sample ◽  
Care System

Background There are few data on the on the care experiences of pregnant women with rifampicin-resistant TB. Objective To describe the treatment journeys of pregnant women with RR-TB—including how their care experiences shape their identities—and identify areas in which tailored interventions are needed. Methods In this qualitative study in-depth interviews were conducted among a convenience sample from a population of pregnant women receiving treatment for RR-TB. This paper follows COREQ guidelines. A thematic network analysis using an inductive approach was performed to analyze the interview transcripts and notes. The analysis was iterative and a coding system developed which focused on the care experiences of the women and how these experiences affected their perceptions of themselves, their children, and the health care system in which treatment was received. Results Seventeen women were interviewed. The women described multiple challenges in their treatment journeys which required them to demonstrate sustained resilience (i.e. to “be brave”). Care experiences required them to negotiate seemingly contradictory identities as both new mothers—“givers of life”—and RR-TB patients facing a complicated and potentially deadly disease. In terms of their “pregnancy identity” and “RR-TB patient identity” that emerged as part of their care experiences, four key themes were identified that appeared to have elements that were contradictory to one another (contradictory areas). These included: 1) the experience of physical symptoms or changes; 2) the experience of the “mothering” and “patient” roles; 3) the experience of the care they received for their pregnancy and their RR-TB; and 4) the experience of community engagement. There were also three areas that overlapped with both roles and during which identity was negotiated/reinforced and they included: 1) faith; 2) socioeconomic issues; and 3) long-term concerns over the child’s health. At times, the health care system exacerbated these challenges as the women were not given the support they needed by health care providers who were ill-informed or angry and treated the women in a discriminatory fashion. Left to negotiate this confusing time period, the women turned to faith, their own mothers, and the fathers of their unborn children. Conclusion The care experiences of the women who participated in this study highlight several gaps in the current health care system that must be better addressed in both TB and perinatal services in order to improve the therapeutic journeys for pregnant women with RR-TB and their children. Suggestions for optimizing care include the provision of integrated services, including specialized counseling as well as training for health care providers; engagement of peer support networks; provision of socioeconomic support; long-term medical care/follow-up for children born to women who were treated for RR-TB; and inclusion of faith-based services in the provision of care.

scholarly journals Issues Associated With the Management and Governance of Sensor Data and Information to Assist Aging in Place: Focus Group Study With Health Care Professionals (Preprint)

2020 ◽  
Author(s):  
Inga Hunter ◽  
Phoebe Elers ◽  
Caroline Lockhart ◽  
Hans Guesgen ◽  
Amardeep Singh ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Older People ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Information Needs ◽  
Sensor Data ◽  
Care Providers ◽  
Community Based ◽  
Age In Place

BACKGROUND Smart home and telemonitoring technologies have often been suggested to assist health care workers in supporting older people to age in place. However, there is limited research examining diverse information needs of different groups of health care workers and their access to appropriate information technologies. OBJECTIVE The aim of this study was to investigate the issues associated with using technologies that connect older people to their health care providers to support aging in place and enhance older people’s health and well-being. METHODS Seven focus group discussions were conducted comprising 44 health care professionals who provided clinic-based or in-home services to community-dwelling older people. Participants were asked about their information needs and how technology could help them support older people to age in place. The recordings of the sessions were transcribed and thematically analyzed. RESULTS The perspectives varied between the respondents who worked in primary care clinics and those who worked in community-based services. Three overarching themes were identified. The first theme was “access to technology and systems,” which examined the different levels of technology in use and the problems that various groups of health care professionals had in accessing information about their patients. Primary care professionals had access to good internal information systems but they experienced poor integration with other health care providers. The community-based teams had poor access to technology. The second theme was “collecting and sharing of information,” which focused on how technology might be used to provide them with more information about their patients. Primary care teams were interested in telemonitoring for specific clinical indicators but they wanted the information to be preprocessed. Community-based teams were more concerned about gaining information on the patients’ social environment. The third theme was that all respondents identified similar “barriers to uptake”: cost and funding issues, usability of systems by older people, and information security and privacy concerns. CONCLUSIONS The participants perceived the potential benefits of technologies, but they were concerned that the information they received should be preprocessed and integrated with current information systems and tailored to the older people’s unique and changing situations. Several management and governance issues were identified, which needed to be resolved to enable the widespread integration of these technologies into the health care system. The disconnected nature of the current information architecture means that there is no clear way for sensor data from telemonitoring and smart home devices to be integrated with other patient information. Furthermore, cost, privacy, security, and usability barriers also need to be resolved. This study highlights the importance and the complexity of management and governance of systems to collect and disseminate such information. Further research into the requirements of all stakeholder groups and how the information can be processed and disseminated is required.

scholarly journals Issues Associated With the Management and Governance of Sensor Data and Information to Assist Aging in Place: Focus Group Study With Health Care Professionals

10.2196/24157 ◽  
2020 ◽  
Vol 8 (12) ◽  
pp. e24157
Author(s):  
Inga Hunter ◽  
Phoebe Elers ◽  
Caroline Lockhart ◽  
Hans Guesgen ◽  
Amardeep Singh ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Older People ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Information Needs ◽  
Sensor Data ◽  
Care Providers ◽  
Community Based ◽  
Age In Place

Background Smart home and telemonitoring technologies have often been suggested to assist health care workers in supporting older people to age in place. However, there is limited research examining diverse information needs of different groups of health care workers and their access to appropriate information technologies. Objective The aim of this study was to investigate the issues associated with using technologies that connect older people to their health care providers to support aging in place and enhance older people’s health and well-being. Methods Seven focus group discussions were conducted comprising 44 health care professionals who provided clinic-based or in-home services to community-dwelling older people. Participants were asked about their information needs and how technology could help them support older people to age in place. The recordings of the sessions were transcribed and thematically analyzed. Results The perspectives varied between the respondents who worked in primary care clinics and those who worked in community-based services. Three overarching themes were identified. The first theme was “access to technology and systems,” which examined the different levels of technology in use and the problems that various groups of health care professionals had in accessing information about their patients. Primary care professionals had access to good internal information systems but they experienced poor integration with other health care providers. The community-based teams had poor access to technology. The second theme was “collecting and sharing of information,” which focused on how technology might be used to provide them with more information about their patients. Primary care teams were interested in telemonitoring for specific clinical indicators but they wanted the information to be preprocessed. Community-based teams were more concerned about gaining information on the patients’ social environment. The third theme was that all respondents identified similar “barriers to uptake”: cost and funding issues, usability of systems by older people, and information security and privacy concerns. Conclusions The participants perceived the potential benefits of technologies, but they were concerned that the information they received should be preprocessed and integrated with current information systems and tailored to the older people’s unique and changing situations. Several management and governance issues were identified, which needed to be resolved to enable the widespread integration of these technologies into the health care system. The disconnected nature of the current information architecture means that there is no clear way for sensor data from telemonitoring and smart home devices to be integrated with other patient information. Furthermore, cost, privacy, security, and usability barriers also need to be resolved. This study highlights the importance and the complexity of management and governance of systems to collect and disseminate such information. Further research into the requirements of all stakeholder groups and how the information can be processed and disseminated is required.

scholarly journals Understanding How to Support Family Caregivers of Seniors with Complex Needs

2017 ◽  
Vol 20 (2) ◽  
pp. 75-84 ◽  
Author(s):  
Lesley Charles ◽  
Suzette Brémault-Phillips ◽  
Jasneet Parmar ◽  
Melissa Johnson ◽  
Lori-Ann Sacrey
Keyword(s):  
Health Care ◽  
Family Caregivers ◽  
Health Care Providers ◽  
Research Priorities ◽  
Care Providers ◽  
Community Based ◽  
Caregiver Support ◽  
Complex Needs ◽  
Participant Engagement

Purpose of the StudyThe purpose of this study was to describe the experiences and challenges of supporting family caregivers of seniors with complex needs and to outline support strategies and research priorities aimed at supporting them.Design and MethodsA CIHR-funded, two-day conference entitled “Supporting Family Caregivers of Seniors: Improving Care and Caregiver Outcomes” was held. An integrated knowledge translation approach guided this planning conference. Day 1 included presentations of research evidence, followed by participant engagement Qualitative data was collected regarding facilitators, barriers/gaps, and recommendations for the provisionof caregiver supports. Day 2 focused on determination of research priorities.ResultsIdentified facilitators to the provision of caregiver support included accessibility of health-care and community-based resources, availability of well-intended health-care providers, and recognition of caregivers by the system. Barriers/gaps related to challenges with communication, access to information, knowledge of what is needed, system navigation, access to financial resources, and current policies. Recommendations regarding caregiver services and research revolved around assisting caregivers to self-identify and seek support, formalizing caregiver supports, centralizing resources, making system navigation available, and preparing the next generation for caregiving.Implication A better understanding of the needs of family caregivers and ways to support them is critical to seniors’ health services redesign.

scholarly journals “Breaking the Silence” to Improve Cancer Survivorship Care for First Nations Peoples

2018 ◽  
Vol 17 (1) ◽  
pp. 160940691877413
Author(s):  
Wendy Gifford ◽  
Roanne Thomas ◽  
Gwen Barton ◽  
Viviane Grandpierre ◽  
Ian D. Graham
Keyword(s):  
Health Care ◽  
First Nations ◽  
Cancer Survivorship ◽  
Health Care Providers ◽  
Large Scale ◽  
Care Delivery ◽  
Survivorship Care ◽  
Care Providers ◽  
Community Based ◽  
Knowledge To Action

There is a significant knowledge-to-action gap in cancer survivorship care for First Nations (FN) communities. To date, many approaches to survivorship have not been culturally responsive or community-based. This study is using an Indigenous knowledge translation (KT) approach to mobilize community-based knowledge about cancer survivorship into health-care programs. Our team includes health-care providers and cancer survivors from an FN community in Canada and an urban hospital that delivers Cancer Care Ontario’s Aboriginal Cancer Program. Together, we will study the knowledge-to-action process to inform future KT research with Indigenous peoples for improving health-care delivery and outcomes. The study will be conducted in settings where research relations and partnerships have been established through our parent study, The National Picture Project. The inclusion of community liaisons and the continued engagement of participants from our parent study will foster inclusiveness and far-reaching messaging. Knowledge about unique cancer survivorship needs co-created with FN people in the parent study will be mobilized to improve cancer follow-up care and to enhance quality of life. Findings will be used to plan a large-scale implementation study across Canada.

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