Bedrails and Falls in Nursing Homes: A Systematic Review

Bedrail use for fall prevention in elderly clients (>65 years) is controversial. Some healthcare providers believe bedrails prevent falls, while others think they are ineffective and dangerous. A systematic review was conducted to address: “For older adults living in nursing homes, does more or less bedrail use reduce the incidence of falls?” We searched HealthStar, MEDLINE, CINAHL, Academic Search complete ProQuest and Canadian Health Research Collection using “elder*,” “bedrail*,” “fall*,” and “assisted-living*.” After filtering for primary data, English records, older adult population, relationship between bedrails and falls, fourteen studies remained. Results suggest using alternative fall prevention measures, and bedrails are either beneficial, harmful, or do not influence falls. Bedrail reduction with fall prevention interventions led to no changes in fall frequency. Ambiguity persists regarding fall frequencies and bedrail use without using other fall prevention strategies. Educating health care providers on fall prevention is key to patient safety.

Download Full-text

Palliative care transitions from acute care to community-based care: A qualitative systematic review of the experiences and perspectives of health care providers

Palliative Medicine ◽

10.1177/0269216320947601 ◽

2020 ◽

Vol 34 (10) ◽

pp. 1316-1331 ◽

Cited By ~ 1

Author(s):

Tieghan Killackey ◽

Emily Lovrics ◽

Stephanie Saunders ◽

Sarina R. Isenberg

Keyword(s):

Systematic Review ◽

Palliative Care ◽

Acute Care ◽

Health Care Providers ◽

Thematic Analysis ◽

Healthcare Providers ◽

Discharge Process ◽

Care Providers ◽

Community Based ◽

Qualitative Systematic Review

Background: Transitioning from the hospital to community is a vulnerable point in patients’ care trajectory, yet little is known about this experience within the context of palliative care. While some studies have examined the patient and caregiver experience, no study to date has synthesized the literature on the healthcare provider’s perspective on their role and experience facilitating these transitions. Aim: The purpose of this systematic review was to understand the experience and perspective of healthcare providers who support the transition of patients receiving palliative care as they move from acute care to community settings. Design: A qualitative systematic review of studies using thematic analysis as outlined by Thomas and Harden. PROSPERO: ID # CRD42018109662. Data Sources: We searched four databases: MEDLINE, Embase, ProQuest and CINAHL for studies published in English from 1995 until May 22, 2020. Four reviewers screened records using the following selection criteria: (1) peer-reviewed empirical study, (2) adult sample, (3) qualitative study design, (4) perspective of healthcare providers, and (5) included a component of transitions between acute to community-based palliative care. Study findings were analyzed using thematic analysis which entailed: (1) grouping the findings into recurring themes; (2) iteratively referring back to the articles to obtain nuances of the theme and quotations; and (3) defining and solidifying the themes. Results: Overall 1,791 studies were identified and 15 met inclusion criteria. Studies were published recently (>2015, n = 12, 80%) and used a range of qualitative methods including semi-structured interviews, focus groups, and field interviews. Three core themes related to the role and experience of healthcare providers were identified: (1) assessing and preparing for transition; (2) organizing and facilitating the logistics of transition; and (3) coordinating and collaborating transitional care across sectors. The majority of studies focused on the discharge process from acute care; there was a lack of studies exploring the experiences of healthcare providers in the community who receive patients from acute care and provide them with palliative care at home. Conclusion: This review identified studies from a range of relatively high-income countries that included a diverse sample of healthcare providers. The results indicate that healthcare providers experience multiple complex roles during the transition facilitation process, and future research should examine how to better assist clinicians in supporting these transitions within the context of palliative care provision.

Download Full-text

Do patients and health care providers have discordant preferences about which aspects of treatments matter most? Evidence from a systematic review of discrete choice experiments

BMJ Open ◽

10.1136/bmjopen-2016-014719 ◽

2017 ◽

Vol 7 (5) ◽

pp. e014719 ◽

Cited By ~ 20

Author(s):

Mark Harrison ◽

Katherine Milbers ◽

Marie Hudson ◽

Nick Bansback

Keyword(s):

Systematic Review ◽

Healthcare Provider ◽

Discrete Choice ◽

Health Care Providers ◽

Healthcare Providers ◽

Choice Experiments ◽

Discrete Choice Experiments ◽

Care Providers ◽

Healthcare Interventions ◽

Heterogeneity Of Preferences

ObjectivesTo review studies eliciting patient and healthcare provider preferences for healthcare interventions using discrete choice experiments (DCEs) to (1) review the methodology to evaluate similarities, differences, rigour of designs and whether comparisons are made at the aggregate level or account for individual heterogeneity; and (2) quantify the extent to which they demonstrate concordance of patient and healthcare provider preferences.MethodsA systematic review searching Medline, EMBASE, Econlit, PsycINFO and Web of Science for DCEs using patient and healthcare providers. Inclusion criteria: peer-reviewed; complete empiric text in English from 1995 to 31July 2015; discussing a healthcare-related topic; DCE methodology; comparing patients and healthcare providers.DesignSystematic review.ResultsWe identified 38 papers exploring 16 interventions in 26 diseases/indications. Methods to analyse results, determine concordance between patient and physician values, and explore heterogeneity varied considerably between studies. The majority of studies we reviewed found more evidence of mixed concordance and discordance (n=28) or discordance of patient and healthcare provider preferences (n=12) than of concordant preferences (n=4). A synthesis of concordance suggested that healthcare providers rank structure and outcome attributes more highly than patients, while patients rank process attributes more highly than healthcare providers.ConclusionsDiscordant patient and healthcare provider preferences for different attributes of healthcare interventions are common. Concordance varies according to whether attributes are processes, structures or outcomes, and therefore determining preference concordance should consider all aspects jointly and not a binary outcome. DCE studies provide excellent opportunities to assess value concordance between patients and providers, but assessment of concordance was limited by a lack of consistency in the approaches used and consideration of heterogeneity of preferences. Future DCEs assessing concordance should fully report the framing of the questions and investigate the heterogeneity of preferences within groups and how these compare.

Download Full-text

Driving Habits of Older Adults

Kansas Journal of Medicine ◽

10.17161/kjm.v5i4.11423 ◽

2012 ◽

Vol 5 (4) ◽

pp. 134-141

Author(s):

Shelley Bhattacharya ◽

Kristina Diaz

Keyword(s):

Health Care ◽

Health Care Providers ◽

Kansas City ◽

Adult Population ◽

Healthcare Providers ◽

Weather Conditions ◽

Older Drivers ◽

Care Providers ◽

Safe Driving ◽

Driving Behaviors

BACKGROUND: The older adult population is the fastest growing cohort in Kansas, resulting in a growing number of older drivers. With age, changes in the ability to drive can compromise safety. Although it is challenging for health care providers to identify unsafe older drivers, it would be helpful to know what common driving habits they share. This exploratory study evaluated differences in the self-reported driving behaviors of older drivers in urban and rural settings of Kansas. METHODS: A one-page, 19-item survey was administered to patients over age 65 in the waiting rooms of two physician medical offices in urban Kansas City and rural Junction City, Kansas. RESULTS: A total of 105 surveys were completed. Rural drivers reported they were involved in approximately 9% more accidents than the urban drivers (p = 0.166). Rural drivers were more likely to drive in poor weather conditions, such as snow, ice, fog, and rain (p = 0.032). Eyeglasses were worn by 10% of the rural cohort compared to 37.8% of the urban cohort (p = 0.0044). More urban drivers reported they did not want to make changes to their current driving habits (71% vs 40%; p = 0.004). Urban drivers drove a longer distance to reach their destinations. Drivers from both environments avoided unfamiliar roads and did not use cell phones or global positioning system (GPS) devices while driving. CONCLUSIONS: By understanding the habits of older drivers, healthcare providers can tailor safe driving messages to support safe driving and enhance patient safety. Physicians could benefit from knowing that older rural drivers wore their glasses less frequently, trended towards having more accidents, and were more prone to drive during inclement weather. Urban Kansas drivers drove further to get to their destinations than their rural Kansas counterparts. Understanding these driving habits and tailoring their prevention messages accordingly may help health care providers in Kansas improve older patient’s safe driving behaviors.

Download Full-text

“Availability of healthcare providers for rural veterans eligible for purchased care under the veterans choice act”

BMC Health Services Research ◽

10.1186/s12913-018-3108-8 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 8

Author(s):

Michael E. Ohl ◽

Margaret Carrell ◽

Andrew Thurman ◽

Mark Vander Weg ◽

Teresa Hudson ◽

...

Keyword(s):

Health Care ◽

Health Care Providers ◽

Rural Areas ◽

Adult Population ◽

Healthcare Providers ◽

The United States ◽

Veterans Health ◽

Health Administration ◽

Care Providers ◽

Level Data

Abstract Background Military Veterans in the United States are more likely than the general population to live in rural areas, and often have limited geographic access to Veterans Health Administration (VHA) facilities. In an effort to improve access for Veterans living far from VHA facilities, the recently-enacted Veterans Choice Act directed VHA to purchase care from non-VHA providers for Veterans who live more than 40 miles from the nearest VHA facility. To explore potential impacts of these reforms on Veterans and healthcare providers, we identified VHA-users who were eligible for purchased care based on distance to VHA facilities, and quantified the availability of various types of non-VHA healthcare providers in counties where these Veterans lived. Methods We combined 2013 administrative data on VHA-users with county-level data on rurality, non-VHA provider availability, population, household income, and population health status. Results Most (77.9%) of the 416,338 VHA-users who were eligible for purchased care based on distance lived in rural counties. Approximately 16% of these Veterans lived in primary care shortage areas, while the majority (70.2%) lived in mental health care shortage areas. Most lived in counties that lacked specialized health care providers (e.g. cardiologists, pulmonologists, and neurologists). Counterintuitively, VHA played a greater role in delivering healthcare for the overall adult population in counties that were farther from VHA facilities (30.7 VHA-users / 1000 adults in counties over 40 miles from VHA facilities, vs. 22.4 VHA-users / 1000 adults in counties within 20 miles of VHA facilities, p < 0.01). Conclusions Initiatives to purchase care for Veterans living more than 40 miles from VHA facilities may not significantly improve their access to care, as these areas are underserved by non-VHA providers. Non-VHA providers in the predominantly rural areas more than 40 miles from VHA facilities may be asked to assume care for relatively large numbers of Veterans, because VHA has recently cared for a greater proportion of the population in these areas, and these Veterans are now eligible for purchased care.

Download Full-text

Quality and women’s satisfaction with maternal referral practices in sub-Saharan African low and lower-middle income countries: A systematic review

10.21203/rs.2.13001/v4 ◽

2020 ◽

Author(s):

Edward Kwabena Ameyaw ◽

Carolyne Njue ◽

Nguyen Toan Tran ◽

Angela Dawson

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Low Cost ◽

Healthcare Providers ◽

Primary Data ◽

Care Providers ◽

Middle Income ◽

Middle Income Countries ◽

Referral Practices ◽

Sub Saharan

Abstract Background: sub-Saharan African Low and Lower-Middle Income Countries (sSA LLMICs) have the highest burden of maternal and perinatal morbidity and mortality in the world. Timely and appropriate maternal referral to a suitable health facility is an indicator of effective health systems. In this systematic review we aimed to identify which referral practices are delivered according to accepted standards for pregnant women and newborns in sSA LLMICs by competent healthcare providers in line with the needs of pregnant women.Methods: Six electronic databases were systematically searched for primary data studies (2009-2018) in English reporting on maternal referral practices and their effectiveness. We conducted a content analysis guided by a framework for assessing the quality of maternal referral. Quality referral was defined as: timely identification of signal functions, established guidelines or standards, adequate documentation, staff accompaniment and prompt care by competent healthcare providers in the receiving facility.Results: Seventeen articles were included in the study. Most studies were quantitative (n=11). Two studies reported that women were dissatisfied due to delays in referral processes that affected their health. Most articles (10) reported that women were not accompanied to higher levels of care, delays in referral processes, transport challenges and poor referral documentation. Some healthcare providers administered essential drugs such as misoprostol prior to referral.Conclusions: Efforts to improve maternal health in LLMICs should aim to enhance maternity care providers’ ability to identify conditions that demand referral. Low cost transport is needed to mitigate barriers of referral. To ensure quality maternal referral, district level health managers should be trained and equipped with the skills needed to monitor and evaluate referral documentation, including quality and efficiency of maternal referrals. Systematic review registration: PROSPERO registration CRD42018114261

Download Full-text

Quality and women’s satisfaction with maternal referral practices in sub-Saharan African low and lower-middle income countries: a systematic review

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03339-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Edward Kwabena Ameyaw ◽

Carolyne Njue ◽

Nguyen Toan Tran ◽

Angela Dawson

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Low Cost ◽

Healthcare Providers ◽

Primary Data ◽

Care Providers ◽

Middle Income ◽

Middle Income Countries ◽

Referral Practices ◽

Sub Saharan

Abstract Background sub-Saharan African Low and Lower-Middle Income Countries (sSA LLMICs) have the highest burden of maternal and perinatal morbidity and mortality in the world. Timely and appropriate maternal referral to a suitable health facility is an indicator of effective health systems. In this systematic review we aimed to identify which referral practices are delivered according to accepted standards for pregnant women and newborns in sSA LLMICs by competent healthcare providers in line with the needs of pregnant women. Methods Six electronic databases were systematically searched for primary data studies (2009–2018) in English reporting on maternal referral practices and their effectiveness. We conducted a content analysis guided by a framework for assessing the quality of maternal referral. Quality referral was defined as: timely identification of signal functions, established guidelines or standards, adequate documentation, staff accompaniment and prompt care by competent healthcare providers in the receiving facility. Results Seventeen articles were included in the study. Most studies were quantitative (n = 11). Two studies reported that women were dissatisfied due to delays in referral processes that affected their health. Most articles (10) reported that women were not accompanied to higher levels of care, delays in referral processes, transport challenges and poor referral documentation. Some healthcare providers administered essential drugs such as misoprostol prior to referral. Conclusions Efforts to improve maternal health in LLMICs should aim to enhance maternity care providers’ ability to identify conditions that demand referral. Low cost transport is needed to mitigate barriers of referral. To ensure quality maternal referral, district level health managers should be trained and equipped with the skills needed to monitor and evaluate referral documentation, including quality and efficiency of maternal referrals. Trial registration Systematic review registration: PROSPERO registration CRD42018114261.

Download Full-text

COVID-19 in Assisted Living: Evidence on Policies, Provider Experiences, and Resident Mortality

Innovation in Aging ◽

10.1093/geroni/igab046.216 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 57-57

Author(s):

Kali Thomas ◽

Lindsay Schwartz

Keyword(s):

Health Care Providers ◽

Assisted Living ◽

Long Term Care ◽

Healthcare Providers ◽

Care Providers ◽

Term Care ◽

Key Stakeholders ◽

National Organizations ◽

Poor Outcomes

Abstract The devastating effects of Coronavirus disease 2019 (COVID-19) among older adults residing in long-term care settings has been well documented. Assisted living settings in the U.S. have 811,000 residents; most are 80 years or older, and many have one or more chronic illnesses, making them highly susceptible to poor outcomes if exposed to COVID-19. This symposium highlights five studies that focus on various levels of COVID-19 response in assisted living: national organizations, states, assisted living operators and healthcare providers, and residents. The first study compares the sometimes conflicting guidance provided by national long-term care industry-related organizations and recommends assisted living-specific actions for the future. The second study describes the state regulatory response to COVID-19 in assisted living, identifying the themes and implications for the function of the care networks of assisted living residents. The third study presents findings from interviews with key stakeholders, including policymakers and industry leaders, that reflect on the challenges responding to changing recommendations and policies. The fourth study reports results from a survey with administrators and medical and mental health care providers who treat their residents that illustrates the care practices that were implemented in response to COVID-19 in assisted living. The fifth presentation documents the national excess assisted living resident mortality that was attributable to COVID-19. This symposium culminates with a leading assisted living industry expert reflecting on providers’ experiences and posing areas to consider when preparing for and responding to future pandemic events in assisted living settings.

Download Full-text

Current Practices and Challenges of Medical Services on Health Care System of Mandalay General Hospital

Myanmar Health Sciences Research Journal ◽

10.34299/mhsrj.00936 ◽

2019 ◽

Vol 31 (2) ◽

pp. 131

Keyword(s):

Health Care ◽

General Hospital ◽

Health Care Providers ◽

Quality Care ◽

Healthcare Providers ◽

Medical Services ◽

Tertiary Level ◽

Care Providers ◽

Level Hospital ◽

Care System

In Myanmar, the main challenge to provide quality healthcare by Universal Health Care approach is documented as low health services coverage with substantial wealth-based inequality. To achieve the effective health care system, strong medical care system is essential. Understanding on challenges and needs in provision of medical services among patients and health care providers is critical to provide quality care with desirable outcomes. The aim of the study was to explore the patients’ and health care providers’ perceptions on the challenges in provision of medical services at the Mandalay General Hospital. This was a qualitative study conducted at the tertiary level hospital (Mandalay General Hospital). The data was collected by using focus group discussions and in-depth interviews with hospitalized patients or attendants, healthcare providers such as medical doctors, nurses, laboratory scientists and hospital administrators in March 2017. The qualitative data was analyzed using themes by themes matrix analysis. Most patients were satisfied with the care provided by the doctors because they believed that they received quality care. However, some patients complained about long waiting time for elective operation, congested conditions in the ward, burden for investigations outside the hospital for urgent needs and impolite manners of general workers. Healthcare providers reported that they had heavy workload due to limited human and financial resources in the hospital, poor compliances with hospital rules and regulation among patients and attendants, and inefficient referral practices from other health facilities. Other challenges experienced by healthcare providers were lack of ongoing training to improve knowledge and skills, limited health infrastructure and inadequate medicinal supplies. The findings highlighted the areas needed to be improved to provide quality health care at the tertiary level hospital. The challenges and problems encountered in this hospital can be improved by allocating adequate financial and human resources. The systematic referral system and hospital management guidelines are needed to reduce workload of health staff.

Download Full-text

COVID-19: knowledge, awareness and perceived stress among Jordanian healthcare providers (Preprint)

10.2196/preprints.22978 ◽

2020 ◽

Author(s):

Emad Aborajooh ◽

Mohammed Qussay Al-Sabbagh ◽

Baraa Mafrachi ◽

Muhammad Yassin ◽

Rami Dwairi ◽

...

Keyword(s):

Social Media ◽

Psychological Stress ◽

Health Care Providers ◽

Best Practice ◽

Healthcare Providers ◽

Cross Sectional Study ◽

Care Providers ◽

Cross Sectional ◽

Ordinal Logistic Regression Analysis ◽

Source Of Information

UNSTRUCTURED We aimed to measure levels of knowledge, awareness, and stress about COVID-19 among health care providers (HCP) in Jordan. This was a cross-sectional study on 397 HCPs that utilized an internet-based questionnaire to evaluate knowledge about COVID-19, availability of personal protective equipment (PEE), future perception, and psychological distress. Ordinal logistic regression analysis was used to evaluate factors associated with knowledge and psychological stress. Overall, 24.4% and 21.2% of the participants showed excellent knowledge and poor knowledge, respectively. Social media (61.7%) was the most commonly used source of information. Being female (β= 0.521, 95% CI 0.049 to 0.992), physician (β=1.421, 95% CI 0.849 to 1.992), or using literature to gain knowledge (β= 1.161, 95% CI 0.657 to 1.664) were positive predictors of higher knowledge. While having higher stress (β= -0.854, 95% CI -1.488 to -0.221) and using social media (β= -0.434, 95% CI -0.865 to -0.003) or conventional media (β= -0.884, 95% CI -1.358 to -0.409) for information were negative predictors of knowledge levels. HCPs are advised to use the literature as a source of information about the virus, its transmission, and the best practice. PPEs should be secured for HCPs to the psychological stress associated with treating COVID-19 patients.

Download Full-text

407 - The Baycrest Quick-Response Caregiver Tool: The Role for a New Tool for Caregivers of Persons with Dementia

International Psychogeriatrics ◽

10.1017/s1041610220002604 ◽

2020 ◽

Vol 32 (S1) ◽

pp. 123-123

Author(s):

Ken Schwartz ◽

Robert Madan ◽

Anna Berall ◽

Marsha Natadira ◽

Anna Santiago

Keyword(s):

Family Caregivers ◽

Health Care Providers ◽

Healthcare Providers ◽

Well Being ◽

Moderate Degree ◽

Quick Response ◽

Care Providers ◽

High Level ◽

Person With Dementia ◽

The Impact

Background:Responsive behaviours in dementia are associated with poor outcomes for the person with dementia (PWD) and caregiver burnout. Family caregivers need a variety of tools to manage responsive behaviours. The Baycrest Quick-Response Caregiver Tool was developed to provide caregivers with a tool that can be used in real time. In this study, the feasibility, impact, and effectiveness of this new tool were studied in family caregivers and health care providers (HCP) using quantitative and qualitative measures.Methods:Family caregivers were recruited and were asked to complete a pre-survey before being sent the link to the educational tool. One month after the telephone survey, caregivers were sent an online post-survey to gather their feedback on the tool and the impact of the tool on caregiver well -being. Healthcare providers were also recruited and reviewed the tool through an online feedback survey. The feasibility, impact, and effectiveness of the tool were assessed using quantitative and qualitative measures.Results:Caregivers had a moderate degree of and reported a high level of competence - these scores were maintained throughout the study. Caregivers reported that tool positively impacted their compassion towards the person with dementia (PWD), and that their interactions with improved. 100% of HCP who completed the feedback survey would recommend the tool to other HCP and to caregivers of PWD. The caregivers and HCP provided specific suggestions for improvement.Conclusions:The Baycrest Quick-Response Caregiver Tool was found to be feasible and helpful. It provides caregivers and HCP with an additional approach for responsive behaviours.

Download Full-text