scholarly journals Care Planning: What Works, for Whom, and in What Circumstances? A Rapid Realist Review

2018 ◽  
Vol 28 (14) ◽  
pp. 2250-2266 ◽  
Author(s):  
Sarah Brown ◽  
Monique Lhussier ◽  
Sonia M. Dalkin ◽  
Simon Eaton
Keyword(s):  
Health Care ◽  
Care Setting ◽  
Review Process ◽  
Realist Review ◽  
Care Planning ◽  
Empirical Testing ◽  
Long Term Conditions ◽  
What Works ◽  
Rapid Realist Review

Care planning has been described as a “better conversation” that helps people with long-term conditions to be in control of planning their care. Each person with long-term conditions faces individual challenges and each health care setting is fundamentally different, so there is a need for empirical testing of the specific mechanisms through which care planning may lead to health improvements. A rapid realist review was conducted to unearth underpinning mechanisms leading to outcomes in particular contexts. These are expressed in the form of realist theories, which are developed and refined through the review process. Fifty-one full text studies were included in the review. Seven program theories were iteratively tested and refined. A detailed description of what care planning is and what it should look like in practice has been achieved in the form of realist theories.

scholarly journals Telemedical Coaching Improves Long-Term Weight Loss in Overweight Persons: A Randomized Controlled Trial

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Kerstin Kempf ◽  
Martin Röhling ◽  
Monika Stichert ◽  
Gabriele Fischer ◽  
Elke Boschem ◽  
...  
Keyword(s):  
Health Care ◽  
Weight Loss ◽  
Occupational Health ◽  
Care Setting ◽  
Health Care Setting ◽  
Control Group ◽  
Lifestyle Interventions ◽  
Occupational Health Care ◽  
Weight Losses

Background. Lifestyle interventions have shown to be effective when continuous personal support was provided. However, there is lack of knowledge whether a telemedical-approach with personal coaching contributes to long-term weight losses in overweight employees. We, therefore, tested the hypothesis that telemedical-based lifestyle interventions accompanied with telemedical coaching lead to larger weight losses in overweight persons in an occupational health care setting. Methods. Overweight employees (n=180) with a body mass index (BMI) of >27 kg/m2 were randomized into either a telemedical (TM) group (n=61), a telemedical coaching (TMC) group (n=58), or a control group (n=61). Both intervention groups were equipped with scales and pedometers automatically transferring the data into a personalized online portal, which could be monitored from participants and coaches. Participants of the TMC group received additionally one motivational care call per week by mental coaches to discuss the current data (current weight and steps) and achieving goals such as a healthy lifestyle or weight reduction. The control group remained in routine care. Clinical and anthropometric data were determined after the 12-week intervention. Additionally, weight change was followed up after 12 months. Results. Participants of TMC (-3.1 ± 4.8 kg, p<0.0001) and TM group (-1.9 ± 4.0 kg; p=0.0012) significantly reduced weight and sustained it during the 1-year follow-up, while the control group showed no change. Compared to the control group only weight loss in the TMC group was significantly different (p<0.001) after 12 months. TMC and TM group also reduced BMI, waist circumference, and LDL cholesterol. Moreover, TMC group improved additionally systolic and diastolic blood pressure, total cholesterol, HDL cholesterol, and HbA1c. Conclusions. Telemedical devices in combination with telemedical coaching lead to significant long-term weight reductions in overweight persons in an occupational health care setting. This study is registered with NCT01868763, ClinicalTrials.gov.

Recognition and assessment of dementia in primary care

2019 ◽  
Vol 30 (9) ◽  
pp. 438-443
Author(s):  
Karen Harrison-Dening
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Signs And Symptoms ◽  
Assessment Tools ◽  
Long Term Conditions ◽  
Practice Nurses ◽  
Memory Assessment ◽  
Neurology Clinic

While patients diagnosed with dementia will require management from specialist neurology clinics, practice nurses play an important role in their health. Karen Harrison-Dening explains what assessment tools are available for patients with particular health needs The majority of patients are diagnosed in a memory assessment service or a neurology clinic. However, early detection of a possible dementia is often done in a primary care setting. Dementia diagnosis has been seen by some as a ‘tick-box exercise’ but there are significant benefits to patients and their families when screening or testing for dementia is carried out early, especially in supporting the patients management of other comorbid or long-term conditions. Nurses working in primary care have a key role in identifying patients who may have the signs and symptoms of dementia by enabling them to access a timely diagnosis.

scholarly journals Clarifying the mechanisms and resources that enable the reciprocal involvement of seldom heard groups in health and social care research: A collaborative rapid realist review process

2019 ◽  
Vol 22 (3) ◽  
pp. 298-306 ◽  
Author(s):  
Éidín Ní Shé ◽  
Sarah Morton ◽  
Veronica Lambert ◽  
Cliona Ní Cheallaigh ◽  
Vanessa Lacey ◽  
...  
Keyword(s):  
Review Process ◽  
Social Care ◽  
Realist Review ◽  
Care Research ◽  
Health And Social Care ◽  
Rapid Realist Review

Patients' experiences of nurse case management in primary care: a meta-synthesis

2017 ◽  
Vol 23 (5) ◽  
pp. 420 ◽  
Author(s):  
Anna Askerud ◽  
Jenny Conder
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Case Management ◽  
Research Question ◽  
Health Conditions ◽  
Long Term Conditions ◽  
Nurse Case Management ◽  
Primary Health

The health system in New Zealand and Australia requires health practitioners to prepare for the challenge of long-term conditions. Wagner’s 1998 Chronic Care Model advocates a move away from the traditional acute model of primary health care to a model that addresses the long-term episodic nature of chronic disease. Nurse case management has been developed over the last 2 decades as a means to coordinate health services for people with long-term conditions. This meta-synthesis combines the results of 15 qualitative research studies that have a similar research question regarding peoples’ perceptions of nurse case management. The research synthesises the experiences of people with long-term conditions on the quality of care under a nurse case management model of primary health care. Over 1000 people were represented across the studies, and the results suggest that people had a high degree of confidence and trust in their nurse case manager, were better able to manage their health conditions with nurse case management support, and had better access to appropriate health care. This research suggests that nurse case management is an effective model of care and may contribute to improved quality of life and better health care for those with long-term health conditions.

Prevalence and Benefits of Care Plans and Care Planning for People with Long-Term Conditions in England

2012 ◽  
Vol 17 (1_suppl) ◽  
pp. 64-71 ◽  
Author(s):  
Jenni Burt ◽  
Martin Roland ◽  
Charlotte Paddison ◽  
David Reeves ◽  
John Campbell ◽  
...  
Keyword(s):  
Patient Survey ◽  
Care Plan ◽  
Care Planning ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Long Term Conditions ◽  
Patient Reports ◽  
Care Plans ◽  
Interpersonal Care

Objectives Among patients with long-term conditions, to determine the prevalence and benefits of care planning discussions and of care plans. Methods Data from the 2009/10 General Practice Patient Survey, a cross sectional survey of 5.5 million patients in England. Outcomes were patient reports of: care planning discussions; perceived benefit from care planning discussions and resultant care plans. Patient and practice variables were included in multilevel logistic regression to investigate predictors of each outcome. Results Half the respondents (49%) reported a long-term condition and were eligible to answer the care planning questions. Of these, 84% reported having a care planning discussion during the last 12 months and most reported some benefit. Only 12% who reported a care planning discussion also reported being told they had a care plan. Patients who reported having a care plan were more likely to report benefits from care planning discussions. Several factors predicted the reporting of care planning and care plans of which the most important was patients' reports of the quality of interpersonal care. Conclusions There is a gap between policy and current practice which might reflect uncertainty as to the benefits of care plans. There is, therefore, a need for rigorous evaluation of care plans.

scholarly journals 72 Adult Safeguarding, Abuse of Vulnerable Adults and Mandatory Reporting: A Rapid Realist Review of the Literature

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Sarah Donnelly
Keyword(s):  
Older People ◽  
Realist Review ◽  
Mandatory Reporting ◽  
Professional Judgment ◽  
Policy And Practice ◽  
Institutional Settings ◽  
What Works ◽  
The Individual ◽  
Vulnerable Adults ◽  
Rapid Realist Review

Abstract Background The continuing evolution of adult safeguarding legislation, policy and practice in relation to the abuse of vulnerable adults reflects a growing awareness of the nature and extent of such abuse in Ireland. The Adult Safeguarding Bill, 2017 represents a progressive step in safeguarding older people and vulnerable adults. The intention of the Bill is to put in place additional protections for adults, in particular, for those who may be unable to protect themselves, such as older people or those lacking capacity. Part 3 provides for mandatory reporting by specified/named persons/professionals. This paper sets out to critically analyse the concept of mandatory reporting within adult safeguarding using international comparators as case studies. Methods A rapid realist review of adult safeguarding reporting typologies and systems in five key jurisdictions: Australia, Canada, England, Northern Ireland and Scotland, were explored to answer the question: ‘what works, for whom and in what circumstances?’ [1] Results Jurisdictions differ as to who the mandated reporters are, the scope and powers of mandatory reporting, and the types of abuse subject to reporting. Of significance is that the debate on mandatory reporting has increasingly focused on institutional settings, rather than more broadly across services. Key concepts identified are those of protection, empowerment and proportionality. Adult safeguarding legislation must therefore ensure that interventionist and compulsory measures to protect do not excessively restrict the rights of the individual. Conclusion Mandatory reporting may offer professionals increased powers to prevent and reduce the abuse of adults and older people, but this could also change the dynamic of relationships within families, and between families and professionals. Ultimately, the success of any legal approach will rest with professional judgment in balancing autonomy with protection.

Comparing ICD-9-CM and ICD-10 Classification Systems in a Primary Health Care Setting: Some Initial Observations

1995 ◽  
Vol 25 (3) ◽  
pp. 83-86 ◽  
Author(s):  
Sue Walker ◽  
Maryann Wood ◽  
Jeffrey Wilks ◽  
Jennifer Nicol
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Care Setting ◽  
Classification Systems ◽  
Empirical Testing ◽  
Primary Health Care Setting ◽  
Health Clinics ◽  
Primary Health ◽  
Icd 10 ◽  
Using Data

The ICD-10 is due to be introduced into Australia during the late 1990s, superseding the current and widely used ICD-9-CM. Improvements in areas such as number of codes, an expanded external cause framework, and more context to injuries are expected to make the ICD-10 a more streamlined system for practitioners. The present study examined both classification formats using data from 1183 presentations to primary health clinics at island tourist resorts. Some initial observations are made about differences in the two systems, highlighting the greater coding detail provided by the ICD-10, particularly in the area of injuries. It is recommended that further empirical testing be undertaken using the ICD-10 in a variety of settings so as to identify benefits in the coding of both medical conditions and injuries.

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