scholarly journals Exploring the impact of pharmacist comprehensive annual care plans on perceived quality of chronic illness care by patients in Alberta, Canada

2021 ◽  
pp. 171516352110203
Author(s):  
Candace Necyk ◽  
Jeffrey A. Johnson ◽  
Ross T. Tsuyuki ◽  
Dean T. Eurich
Keyword(s):  
Quality Of Care ◽  
Chronic Illness ◽  
Care Plan ◽  
Short Version ◽  
Chronic Illness Care ◽  
Online Questionnaire ◽  
Care Plans ◽  
Funding Program ◽  
The Impact

Background: In 2012, the Government of Alberta introduced a funding program to remunerate pharmacists to develop a comprehensive annual care plan (CACP) for patients with complex needs. The objective of this study is to explore patients’ perceptions of the care they received through the pharmacist CACP program in Alberta. Methods: We invited 3442 patients who received a pharmacist-billed CACP within the previous 3 months and 6888 matched controls across Alberta to complete an online questionnaire. The questionnaire consisted of the short version Patient Assessment of Chronic Illness Care (PACIC-11), with 3 additional pharmacy-specific assessment questions added. Additional questions related to health status and demographics were also included. Results: Overall, most patients indicated a low level of chronic illness care by pharmacists, with few differences noted between CACP patients and non-CACP controls. Of note, controls reported higher quality of care for 5 domains within the adapted PACIC-like tool compared with CACP patients ( p < 0.05 for all). Interestingly, only 79 (44%) of CACP patients reported that they had received a CACP, whereas only 192 (66%) of control patients reported that they did not receive a care plan. In a sensitivity analysis including only these respondents, individuals who received a CACP perceived a significantly higher quality of chronic illness care across all PACIC domains. Conclusion: Overall, chronic illness care incentivized by the pharmacist CACP program in Alberta is perceived to be moderate to low. When limited to respondents who explicitly recognized receiving the service or not, the perceptions of quality of care were more positive. This suggests that better implementation of CACP by pharmacists may be associated with improved quality of care and that some redesign is needed to engage patients more. Can Pharm J (Ott) 2021;154:xx-xx.

The Teamwork Study: enhancing the role of non-GP staff in chronic disease management in general practice

2013 ◽  
Vol 19 (3) ◽  
pp. 184 ◽  
Author(s):  
D. A. Black ◽  
J. Taggart ◽  
U. W. Jayasinghe ◽  
J. Proudfoot ◽  
P. Crookes ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Chronic Disease ◽  
Chronic Illness ◽  
Team Work ◽  
Chronic Illness Care ◽  
Patient Assessment ◽  
Significant Difference ◽  
The Impact

There is evidence for a team-based approach in the management of chronic disease in primary health care. However, the standard of care is variable, probably reflecting the limited organisational capacity of health services to provide the necessary structured and organised care for this group of patients. This study aimed to evaluate the impact of a structured intervention involving non-GP staff in GP practices on the quality of care for patients with diabetes or cardiovascular disease. A cluster randomised trial was undertaken across 60 GP practices. The intervention was implemented in 30 practices with staff and patients interviewed at baseline and at 12–15 months follow up. The change in team roles was evaluated using a questionnaire completed by practice staff. The quality of care was evaluated using the Patient Assessment of Chronic Illness Care questionnaire. We found that although the team roles of staff improved in the intervention practices and there were significant differences between practices, there was no significant difference between those in the intervention and control groups in patient-assessed quality of care after adjusting for baseline-level score and covariates at the 12-month follow up. Practice team roles were not significantly associated with change in Patient Assessment of Chronic Illness Care scores. Patients with multiple conditions were more likely to assess their quality of care to be better. Thus, although previous research has shown a cross-sectional association between team work and quality of care, we were unable to replicate these findings in the present study. These results may be indicative of insufficient time for organisational change to result in improved patient-assessed quality of care, or because non-GP staff roles were not sufficiently focussed on the aspects of care assessed. The findings provide important information for researchers when designing similar studies.

scholarly journals Patient-assessed quality of care in type 2 diabetes in a German nationwide health survey 2017

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
J Baumert ◽  
G L Schmid ◽  
Y Du ◽  
R Paprott ◽  
S Carmienke ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Quality Of Care ◽  
Chronic Illness ◽  
Information Needs ◽  
Population Based ◽  
Short Version ◽  
Chronic Illness Care ◽  
Related Factors

Abstract Background Patient-assessed quality of chronic illness care is important to guide medical care for patients with diabetes and other complex chronic diseases, but information from epidemiological studies is scarce. Thus, we examined self-assessed quality of care among adults with type 2 diabetes (T2D) based on a population-based design. Methods The study population was drawn from a nationwide survey on diabetes-related knowledge and information needs conducted in Germany in 2017 and included participants aged ≥18 years with known type 2 diabetes (T2D) in the last 12 months (n = 1,328). A German short version of the “Patient assessment of chronic illness care (PACIC-DSF)” consisting of 9 items based on 5-point Likert scale was applied to assess self-reported quality of care in diabetes which was operationalized by a standardized PACIC sum score ranging from 1 to 5. Linear regression with different stages of adjustment was applied to assess the association of basic characteristics and diabetes-related factors with the PACIC score. Results Quality of care was assessed less favorably by women than by men (PACIC score: 2.38 vs. 2.47) overall and decreased along with age. The PACIC score significantly increased in participants with insulin use (β = 0.16, p = 0.024), ever participating in a diabetes education program (β = 0.33, p &lt; 0.001), following a diet plan at least once a week (β = 0.33, p &lt; =0.001) as well as performing daily self-examination of feet (β = 0.14, p = 0.023), self-control of blood glucose (β = 0.34, p &lt; 0.001), and being physically active for at least 30 min (β = 0.21, p &lt; 0.001) compared to participants without the respective trait. Conclusions Self-assessed quality of care by adults with known T2D from this population-based study is moderate and seems lower compared to findings from clinical studies. Key messages An active involvement of people with type 2 diabetes into the implementation of care is essential and may contribute to improved self-perceived quality of care. To identify and overcome obstacles in diabetes care based on the patient’s perspective remains a public health challenge.

Randomized trial assessing the impact of survivorship care plans on the quality of care for childhood cancer survivors.

2016 ◽  
Vol 34 (15_suppl) ◽  
pp. 10007-10007
Author(s):  
Cary Philip Gross ◽  
Wilhelmenia Lee Ross ◽  
Jaime L. Rotatori ◽  
Hannah-Rose Mitchell ◽  
Xiaomei Ma ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Cancer Survivors ◽  
Randomized Trial ◽  
Childhood Cancer ◽  
Childhood Cancer Survivors ◽  
Survivorship Care Plans ◽  
Survivorship Care ◽  
Care Plans ◽  
The Impact

scholarly journals Patients’ Assessment of Care for Type 2 Diabetes: Results of the Patient Assessment of Chronic Illness Care Scale in A Danish Population

2020 ◽  
Author(s):  
Anne Frølich ◽  
Ann Nielsen ◽  
Charlotte Glümer ◽  
Hanne Birke ◽  
Christian U Eriksen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Quality Of Care ◽  
Chronic Illness ◽  
Diabetes Care ◽  
Emergency Department Visits ◽  
Descriptive Statistics ◽  
Chronic Illness Care ◽  
Patient Assessment

Abstract Background: The Patient Assessment of Chronic Illness Care (PACIC) scale is the most appropriate for assessing self-reported experience in chronic care. However, it has yet to be validated in a Danish diabetes population. We aimed to validate the PACIC, assess the quality of care for Danish patients with type 2 diabetes, and identify factors associated with quality of care. Methods: A survey of 7,745 individuals randomly selected from the National Diabetes Registry. Descriptive statistics inter-item and item-rest correlations and factor analysis assessed the PACIC properties. Quality of care was analysed with descriptive statistics; linear and multiple regression assessed the effect of forty-nine covariates on total and subscale scores. Results: In total, 2,696 individuals with type 2 diabetes completed ≥ 50% of items. The floor effect for individual items was 8.5-74.5%; the ceiling effect was 4.1- 47.8 %. Cronbach’s alpha was 0.73-0.86 for the five subscales. The comparative fit index (CFI) and the Tucker–Lewis index (TLI) were 0,87, and 0,84, respectively. Mean PACIC score was 2.44 (± 0.04). Respondents receiving rehabilitation and reporting primary of diabetes care had higher total mean scores; those 70 years or older had lower mean total and subscale scores. A higher number of diabetes visits were associated with higher total scores; higher number of emergency department visits were associated with lower total scores. The effect of healthcare utilisation on subscale scores varied. Conclusions: Floor effects suggest a need for further evaluation of the PACIC questionnaire in Danish settings. Total PACIC scores were lower than in other healthcare systems, possibly being a result of different contexts and cultures, and of a need for improving diabetes care in Denmark.

Proactive, multidisciplinary approach to supportive medicine: Improving health outcomes and care utilization.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6537-6537
Author(s):  
Brooke Worster ◽  
Valerie P Csik ◽  
Jared Minetola ◽  
Gregory D. Garber ◽  
Alison Petok ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Cancer Patients ◽  
Hospital Admissions ◽  
Care Plan ◽  
Cancer Center ◽  
Care Plans ◽  
Oncology Care ◽  
The Impact

6537 Background: Evidence suggests that cancer patients who receive palliative care early in their disease have improved quality of life, decreased emergency department (ED) visits, and less aggressive end-of-life care. In 2017, the Sidney Kimmel Cancer Center at Jefferson established the Neu Center for Supportive Medicine and Cancer Survivorship (NCSMCS) as a model for integrated care in the outpatient setting for all cancer patients. A multidisciplinary team consisting of palliative care physicians, social work, psychology, and navigation conducts biopsychosocial screening and initiates a personalized care plan for each patient to clarify treatment goals and offer assistance. Objectives: To use biopsychosocial screening at specified time points to identify needs and evaluate the impact of supportive care as part of standardized oncology care regardless of stage. Methods: This assessment utilized Oncology Care Model (OCM) data for Jefferson Medicare patients between 7/1/16 to 7/31/18. Incidence of ED admits ED/Observation and admissions were evaluated as well as ICU utilization and advanced care planning. Poisson regression was used to generate incidence rate ratios (IRR) and 95% confidence intervals (CI) to facilitate the comparison of post- vs. pre- incidence rates of hospitalization. Results: The post-intervention hospital admissions decreased by 31% in NCSMCS (IRR 0.69; 95% CI 0.48-0.98) and by 10% in Non-NCSMCS (IRR 0.90; 0.84-0.96) and advanced care plans were more likely to be on file for NCSMCS (9.0% vs. 4.9%). The intensive care unit (ICU) admissions were decreased by 17% among Non-NCSMCS (IRR 0.83; 95% CI 0.74-0.93). The utilization rates for ED admissions were not statistically different among both the groups. Conclusions: The preliminary data is promising and impact will be monitored as the intervention is expanded. Reducing admissions has benefits from both a cost savings as well as quality of life perspective. Future analyses will consider the impact of the intervention on a patient’s quality of life.

scholarly journals The Impact of Same Day Infusion Treatment Protocols for Uncomplicated Vaso-Occlusive Crises within an Embedded Sickle Cell Care Model

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 2976-2976
Author(s):  
Stefanie Sacknoff ◽  
Jessica Groesbeck ◽  
Srila Gopal
Keyword(s):  
Quality Of Care ◽  
Sickle Cell ◽  
Case Manager ◽  
Time Frame ◽  
Care Plan ◽  
Cancer Center ◽  
Treatment Protocols ◽  
Clinical Trial Research ◽  
The Impact

Abstract Background: Infusion Center (IC) based care of uncomplicated sickle cell disease (SCD) vaso occlusive crises (VOCs) is very effective and results in better outcomes. At low volume sickle cell programs, it is challenging to acquire resources for a dedicated infusion program. Our goal was to create an embedded infusion program within our cancer center infusion services utilizing existing resources to improve the quality of care for our SCD patients. Methods: A multi-disciplinary team consisting of a Nurse Case Manager, Advanced Practice Provider, MD, IC scheduler and IC charge nurse was assembled. An agreement was made between the SCD team and IC leadership that at least one time slot would be made available for a SCD VOC visit every day. A workflow was created and all team members were educated regarding the workflow. Visit numbers for IC visits, emergency department (ED) and inpatient (IP) hospitalizations were collected from the EMR and compared for pre IC development (Jan 1, 2017- Dec 31, 2018) and post IC (January 1, 2019 - Dec 31, 2020). Results: Between 2017-2020, 182 patients with SCD were seen in the emergency room and 163 patients in our outpatient clinics. After the institution of an IC based care plan in January 2019, IC visit volume increased (270 visits pre IC vs.1076 visits post IC). ED treat and release (not requiring admissions) visits decreased from 373 visits pre IC to 286 visits post IC. The number of inpatient admissions did not change significantly during this time frame. However, the percentage of admissions from the ED increased (43% pre IC to 50% post IC), indicating a higher complexity of patients seeking care from the ED. 10 of 35 patients who used the IC in 2020 had no acute visits (ED or IP) in 2020, while these individual patients had a total of 37 ED visits in the pre IC timeframe, of which 20 were inpatient admissions with a total length of stay of 137 days and 17 treat and release episodes at the ED. Conclusions: Our project successfully utilized existing infusion based resources to facilitate outpatient management of acute uncomplicated SCD VOCs. This project presents an effective strategy that can be utilized by smaller volume sickle cell programs who do not have a stand alone infusion program to improve the quality of care for their SCD patients. Disclosures Gopal: Pharming: Consultancy; GBT: Consultancy; Alexion: Speakers Bureau; Rigel Pharmaceuticals: Other: Clinical Trial, Research Funding.

scholarly journals Patients' assessment of care for type 2 diabetes: Results of the Patient Assessment of Chronic Illness Care scale in a Danish population

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anne Frølich ◽  
Ann Nielsen ◽  
Charlotte Glümer ◽  
Christian U Eriksen ◽  
Helle Terkildsen Maindal ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Quality Of Care ◽  
Chronic Illness ◽  
Diabetes Care ◽  
Descriptive Statistics ◽  
Chronic Illness Care ◽  
Patient Assessment ◽  
Danish Population

Abstract Background The Patient Assessment of Chronic Illness Care (PACIC) scale is the most appropriate for assessing self-reported experience in chronic care. We aimed to validate the PACIC questionnaire by (1) assess patients’ perception of the quality of care for Danish patients with type 2 diabetes, (2) identify which factors are most important to the quality of care designated by the five subscales in PACIC, and (3) the validity of the questionnaire. Methods A survey of 7,745 individuals randomly selected from the National Diabetes Registry. Descriptive statistics inter-item and item-rest correlations and factor analysis assessed the PACIC properties. Quality of care was analysed with descriptive statistics; linear and multiple regression assessed the effect of forty-nine covariates on total and subscale scores. Results In total, 2,696 individuals with type 2 diabetes completed ≥ 50 % of items. The floor effect for individual items was 8.5–74.5 %; the ceiling effect was 4.1–47.8 %. Cronbach’s alpha was 0.73–0.86 for the five subscales. The comparative fit index (CFI) and the Tucker–Lewis index (TLI) were 0,87, and 0,84, respectively. Mean PACIC score was 2.44 (± 0.04). Respondents, who receive diabetes care primarily at general practice and outpatient clinics had higher scores compared to those receiving care at a private specialist. Receiving rehabilitation was followed by higher scores in all subscales. Those 70 years or older had lower mean total and subscale scores compared to younger patient groups. A higher number of diabetes visits were associated with higher total scores; a higher number of emergency department visits were associated with lower total scores. The effects of healthcare utilisation on subscale scores varied. Conclusions These results provide insight into variations in the quality of provided care and can be used for targeting initiatives towards improving diabetes care. Factors important to the quality of perceived care are having a GP or hospital outpatient clinic as the primary organization. Also having a higher number of visits to the two organizations are perceived as higher quality of care as well as participating in a rehabilitation program. Floor and ceiling effects were comparable to an evaluation of the PACIC questionnaire in a Danish population. Yet, floor effects suggest a need for further evaluation and possible improvement of the PACIC questionnaire in a Danish setting. Total PACIC scores were lower than in other healthcare systems, possible being a result of different contexts and cultures, and of a need for improving diabetes care in Denmark.

Evaluation of the nursing care plan in a thyroidectomy surgical case

2021 ◽  
Vol 12 (4) ◽  
pp. 156-160
Author(s):  
Emma McCluskey
Keyword(s):  
Quality Of Care ◽  
Nursing Care ◽  
Care Plan ◽  
Nursing Interventions ◽  
High Quality ◽  
Care Plans ◽  
Surgical Case ◽  
Post Surgery ◽  
Potential Problems

Veterinary nurses work closely with their patients to deliver a high quality of care. This care is implemented using nursing care plans (NCPs). This article aims to evaluate the use of a nursing care plan and its value in practice as well as enhancing nurses' understanding of them. Within this article the author will be discussing the actual and potential problems and implementing the nursing interventions in a nursing care plan pre, post surgery and at discharge in a thyroidectomy case. Veterinary nurses play an important role in making sure the NCP is successful and patients receive the best quality of care. This article evaluates the benefits and disadvantages of NCPs to determine whether they are useful for nursing care of surgical cases.

Reduced influence of affective disorders on perioperative complication rates, length of hospital stay, and healthcare costs following spinal fusion for adolescent idiopathic scoliosis

2019 ◽  
Vol 24 (6) ◽  
pp. 722-727
Author(s):  
Aladine A. Elsamadicy ◽  
Andrew B. Koo ◽  
Megan Lee ◽  
Adam J. Kundishora ◽  
Christopher S. Hong ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Idiopathic Scoliosis ◽  
Affective Disorder ◽  
Affective Disorders ◽  
Complication Rates ◽  
Total Cost ◽  
Adolescent Patients ◽  
Perioperative Complication ◽  
The Impact

OBJECTIVEIn the past decade, a gradual transition of health policy to value-based healthcare has brought increased attention to measuring the quality of care delivered. In spine surgery, adolescents with scoliosis are a population particularly at risk for depression, anxious feelings, and impaired quality of life related to back pain and cosmetic appearance of the deformity. With the rising prevalence of mental health ailments, it is necessary to evaluate the impact of concurrent affective disorders on patient care after spinal surgery in adolescents. The aim of this study was to investigate the impact that affective disorders have on perioperative complication rates, length of stay (LOS), and total costs in adolescents undergoing elective posterior spinal fusion (PSF) (≥ 4 levels) for idiopathic scoliosis.METHODSA retrospective study of the Kids’ Inpatient Database for the year 2012 was performed. Adolescent patients (age range 10–17 years old) with AIS undergoing elective PSF (≥ 4 levels) were selected using the International Classification of Diseases, Ninth Revision, Clinical Modification coding system. Patients were categorized into 2 groups at discharge: affective disorder or no affective disorder. Patient demographics, comorbidities, complications, LOS, discharge disposition, and total cost were assessed. The primary outcomes were perioperative complication rates, LOS, total cost, and discharge dispositions.RESULTSThere were 3759 adolescents included in this study, of whom 164 (4.4%) were identified with an affective disorder (no affective disorder: n = 3595). Adolescents with affective disorders were significantly older than adolescents with no affective disorders (affective disorder: 14.4 ± 1.9 years vs no affective disorder: 13.9 ± 1.8 years, p = 0.001), and had significantly different proportions of race (p = 0.005). Aside from hospital region (p = 0.016), no other patient- or hospital-level factors differed between the cohorts. Patient comorbidities did not differ significantly between cohorts. The number of vertebral levels involved was similar between the cohorts, with the majority of patients having 9 or more levels involved (affective disorder: 76.8% vs no affective disorder: 79.5%, p = 0.403). Postoperative complications were similar between the cohorts, with no significant difference in the proportion of patients experiencing a postoperative complication (p = 0.079) or number of complications (p = 0.124). The mean length of stay and mean total cost were similar between the cohorts. Moreover, the routine and nonroutine discharge dispositions were also similar between the cohorts, with the majority of patients having routine discharges (affective disorder: 93.9% vs no affective disorder: 94.9%, p = 0.591).CONCLUSIONSThis study suggests that affective disorders may not have a significant impact on surgical outcomes in adolescent patients undergoing surgery for scoliosis in comparison with adults. Further studies are necessary to elucidate how affective disorders affect adolescent patients with idiopathic scoliosis, which may improve provider approach in managing these patients perioperatively and at follow-up in hopes to better the overall patient satisfaction and quality of care delivered.

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