scholarly journals Structure and processes of emergency observation units with a geriatric focus: a scoping review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pieter Heeren ◽  
Annabelle Hendrikx ◽  
Janne Ceyssens ◽  
Els Devriendt ◽  
Mieke Deschodt ◽  
...  
Keyword(s):  
Scoping Review ◽  
Emergency Care ◽  
Older Patients ◽  
Clinical Care ◽  
Care Needs ◽  
Post Discharge ◽  
Care Services ◽  
Observation Units ◽  
Primary Care Services ◽  
Healthcare Professions

Abstract Background Combining observation principles and geriatric care concepts is considered a promising strategy for risk-stratification of older patients with emergency care needs. We aimed to map the structure and processes of emergency observation units (EOUs) with a geriatric focus and explore to what extent the comprehensive geriatric assessment (CGA) approach was implemented in EOUs. Methods The revised scoping methodology framework of Arksey and O’Malley was applied. Manuscripts reporting on dedicated areas within hospitals for observation of older patients with emergency care needs were eligible for inclusion. Electronic database searches were performed in MEDLINE, EMBASE and CINAHL in combination with backward snowballing. Two researchers conducted data charting independently. Data-charting forms were developed and iteratively refined. Data inconsistencies were judged by a third researcher or discussed in the research team. Quality assessment was conducted with the Methodological Index for Non-Randomized Studies. Results Sixteen quantitative studies were included reporting on fifteen EOUs in seven countries across three continents. These units were located in the ED, immediately next to the ED or remote from the ED (i.e. hospital-based). All studies reported that staffing consisted of at least three healthcare professions. Observation duration varied between 4 and 72 h. Most studies focused on medical and functional assessment. Four studies reported to assess a patients’ medical, functional, cognitive and social capabilities. If deemed necessary, post-discharge follow-up (e.g. community/primary care services and/or outpatient clinics) was provided in eleven studies. Conclusion This scoping review documented that the structure and processes of EOUs with a geriatric focus are very heterogeneous and rarely cover all elements of CGA. Further research is necessary to determine how complex care principles of ‘observation medicine’ and ‘CGA’ can ideally be merged and successfully implemented in clinical care.

Virtual Primary Care Implementation during COVID-19 in High-Income Countries: A Scoping Review (Preprint)

2021 ◽  
Author(s):  
Kristina De Vera ◽  
Priyanka Challa ◽  
Rebecca H Liu ◽  
Kaitlin Fuller ◽  
Anam Shahil Feroz ◽  
...  
Keyword(s):  
Primary Care ◽  
Scoping Review ◽  
Primary Care Physicians ◽  
Underserved Populations ◽  
High Income ◽  
Lessons Learned ◽  
Regulatory Policies ◽  
Care Services ◽  
Virtual Care ◽  
Primary Care Services

BACKGROUND Primary care physicians across the world are grappling with adopting virtual services to provide appropriate patient care during the COVID-19 pandemic. As the crisis continues, it is imperative to recognize the wide-scale barriers and seek strategies to mitigate the challenges of rapid adoption to virtual care felt by patients and physicians alike. OBJECTIVE The purpose of this scoping review was to map the challenges, strategies, and lessons learned from high-income countries that can be mobilized to inform decision-makers on how to best implement virtual primary care services during and after the COVID-19 pandemic. Moreover, the findings of our scoping review identified the barriers and strategies within the Quadruple Aim components, which may prove to be an effective implementation strategy for virtual care adoption in primary care settings. METHODS The two concepts of virtual care and COVID-19 were searched in MEDLINE, EMBASE, and CINAHL on Aug 10, 2020, and Scopus was searched on Aug 15, 2020. The database searches returned 10,549 citations and an additional 766 citations were retrieved from searching the citations from the reference lists of articles that met all inclusion criteria. After deduplication, 6,580 unique citations remained. Following title and abstract screening, 1,260 full-text articles were reviewed, of which 49 articles were included for data extraction, and 38 articles met the eligibility criteria for inclusion in the review. RESULTS Seven factors were identified as major barriers to the implementation of virtual primary care. Of the 38 articles included in this scoping review, 20 (53%) articles focused on challenges to equitable access to care, specifically regarding the lack of access to internet, smartphones, and Internet bandwidth for rural, seniors, and underserved populations. The second most common factor discussed in the articles was the lack of funding for virtual care (n= 14; 37%), such as inadequate reimbursement policies for virtual care. Other factors included negative patient and clinician perceptions of virtual care (n=11; 29%), lack of appropriate regulatory policies (n= 10, 26%), inappropriate clinical workflows (n= 9, 24%), lack of virtual care infrastructure (n= 8; 21%), and lastly, a need for appropriate virtual care training and education for clinicians (n=5;13%). CONCLUSIONS This review identified several barriers and strategies to mitigate those barriers that address the challenges of virtual primary care implementation related to equity, regulatory policies, technology and infrastructure, education, clinician and patient experience, clinical workflows, and funding for virtual care. These strategies included providing equitable alternatives to access care for patients with limited technical literacy and English proficiency and altering clinical workflows to integrate virtual care services. As many countries enter potential subsequent waves of the COVID-19 pandemic, applying early lessons learned to mitigate implementation barriers can help with the transition to equitable and appropriate virtual primary care services.

The Role of the Primary Care Physician in the Care of Children with Serious Heart Disease

PEDIATRICS ◽  
1994 ◽  
Vol 94 (3) ◽  
pp. 284-290
Author(s):  
Paul C. Young ◽  
Yu Shyr ◽  
M. Anthony Schork
Keyword(s):  
Primary Care ◽  
Heart Disease ◽  
Chronic Illness ◽  
Medical Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Care Physician ◽  
Care Needs ◽  
Care Services ◽  
Primary Care Services

Objective. To determine the roles of primary care physicians and specialists in the medical care of children with serious heart disease. Setting. Pediatric Cardiology Division; Tertiary Care Children's Hospital. Subjects. Convenience sample of parents, primary care physicians, and pediatric cardiologists of 92 children with serious heart disease. Design. Questionnaire study; questionnaires based on 16 medical care needs, encompassing basic primary care services, care specific to the child's heart disease and general issues related to chronic illness. Results. All children had a primary care physician (PCP), and both they and the parents (P) reported high utilization of PCP for basic primary care services. However, there was little involvement of PCP in providing care for virtually any aspect of the child's heart disease. Parents expressed a low level of confidence in the ability of PCP in general or their child's own PCP to meet many of their child's medical care needs. Both PCP and pediatric cardiologists (PC) were significantly more likely than parents to see a role for PCP in providing for care specific to the heart disease as well as more general issues related to chronic illness. PC and PCP generally agreed about the role PCP should play, although PC saw a bigger role for PCP in providing advice about the child's activity than PCP themselves did. PC were less likely to see the PCP as able to follow the child for long term complications than PCP did. PC were more likely than PCP to believe that PCP were too busy or were inadequately reimbursed to care for children with serious heart disease. Only about one-third of parents reported discussing psychosocial, family, economic, or genetic issues with any provider, and PCP were rarely involved in these aspects of chronic illness. Conclusions. Primary care physicians do not take an active role in managing either the condition-specific or the more general aspects of this serious chronic childhood illness. With appropriate information and support from their specialist colleagues primary care physicians could provide much of the care for this group of children. Generalists and specialists are both responsible for educating and influencing parents about the role primary care physicians can play in caring for children with serious chronic illness.

Emergencies in older patients

2016 ◽  
Keyword(s):  
Emergency Care ◽  
Older Patients ◽  
Significant Proportion ◽  
Care Staff ◽  
Older Person ◽  
Older Population ◽  
Nursing Assessment ◽  
Care Services ◽  
Clinical Problems ◽  
Emergency Care Services

The increasingly older population has seen a change in the demographics of patients attending urgent and emergency care services over the last 10 to 20 years. It is not unusual for a significant proportion of patients to be over 80 years of age during the course of a shift. It is essential that emergency care staff have an understanding of the specific clinical problems that can present in old age. This chapter covers the nursing assessment of the older person and describes common presentations associated with the older population.

Pediatric Emergency Telehealth

2021 ◽  
pp. 160-170
Author(s):  
Kylie Taylor ◽  
Ameer Mody
Keyword(s):  
Health Care ◽  
Urban Communities ◽  
Pediatric Emergency ◽  
Direct Patient Care ◽  
Care Needs ◽  
Health Networks ◽  
Care Services ◽  
Primary Care Services ◽  
Rural And Urban ◽  
Community Health Networks

Pediatric Emergency Telehealth (PET) has enormous potential to help address the health care needs of children and families. In some regions, health care is particularly fragmented or difficult to access for the pediatric patient. Telehealth may bridge those gaps, improve continuity of care, and enhance communication between children’s hospitals and general pediatricians practicing in both rural and urban communities. Launching a PET service requires careful preparation with community health networks and stakeholders to ensure that the model is providing adjunct services as opposed to on-demand primary care services. General pediatricians’ offices that lack the capability to implement a virtual care system may seek consultation from the PET service in terms of triage, recommendations, or direct patient care. A substantial effort is required at initiation of a PET program but is useful in mitigating disease exposure such as Covid-19, as well as improving emergency department metrics such as patient satisfaction, length of stay, wait times, and revenue capture.

scholarly journals Age-Friendly Primary Health Care: An Assessment of Current Service Provision for Older Adults in Hong Kong

2013 ◽  
Vol 6 ◽  
pp. HSI.S12434 ◽  
Author(s):  
Jean Woo ◽  
Benise Mak ◽  
Fannie Yeung
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Hong Kong ◽  
Older People ◽  
Service Providers ◽  
Care Needs ◽  
Care Services ◽  
Primary Care Services ◽  
Aging Populations ◽  
Training Community

There has been no study evaluating whether primary care services are sufficiently oriented towards the older population in Hong Kong, particularly those with increasing frailty. Since primary care is a key first interface in promotion and maintenance of health in older people, an assessment of the age-friendliness of service provisions is of critical importance in optimizing the health of aging populations. The age-friendliness of primary care services for older people was assessed using focus groups of elderly people and also of service providers who care for them. Discussion content was based on the WHO guidelines for age-friendly primary care in the following areas: Information, education and training, community-based health care management systems, and the physical environment. Desirable improvements were identified in all domains. The findings underscore the need for wider dissemination of health care needs of older people in the primary care setting.

scholarly journals Use of Video-Enabled Tablet for Virtual Care Among Older Veterans

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 197-197
Author(s):  
Maria Yefimova ◽  
Jiaqi Hu ◽  
Cindie Slightam ◽  
Liberty Greene ◽  
Camila Chaudhary ◽  
...  
Keyword(s):  
Primary Care ◽  
Older Patients ◽  
Oldest Old ◽  
Age Groups ◽  
Old Patients ◽  
Younger Patients ◽  
Care Services ◽  
Virtual Care ◽  
Primary Care Services ◽  
Home Based

Abstract With the proliferation of virtual care, healthcare systems are exploring ways to bridge the digital divide among vulnerable patients. Department of Veterans Affairs (VA) is distributing devices for qualifying Veterans to enable video visits with medical providers at home, yet their use among older patients is unknown. This retrospective cohort study used administrative data to characterize the use of VA-loaned iPads among older Veterans compared to younger Veterans and identify demographic predictors of utilization. Among 16,385 patients who were shipped a VA-loaned iPad in 2014-2019, 33.66% (n=5,516) were over 65 years old, and 3.1% (n=503) were over the age of 85. Two thirds (n=6799) of younger patients had a video visit (mean=3 visits) with provider using iPad in the 6 months since shipment, compared to 50% (n=253) of 85+ year-olds (mean=1.8 visits). Most common types of virtual visits for the oldest old patients were for geriatrics or home-based primary care, compared to mental health visits among younger patients. Logistic regression identified characteristics of older patients who were more likely to use iPads, such a marital status, urban location, and lower disease burden, which is similar to their younger counterparts. While older age groups used VA-loaned tablets less frequently, those who engaged with the devices were similar in demographics as their younger counterparts. Older patients used iPads differently, with higher engagement in geriatric and primary care services. Providing devices for virtual care may allow health systems to more easily reach older patients in the comfort of their home.

Accessing primary health care services for transition-aged young adults with cerebral palsy; perspectives of young adults, parents, and physicians

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Erin Brandon ◽  
Marilyn Ballantyne ◽  
Melanie Penner ◽  
Andrea Lauzon ◽  
Erin McCarvill
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Young Adults ◽  
Health Care Services ◽  
Adult Health ◽  
Care Needs ◽  
Medical Needs ◽  
Care Services ◽  
Primary Care Services ◽  
Primary Health Care Services

AbstractBackgroundYoung adults with childhood-onset disabilities experience challenges with accessing age appropriate primary health care services as they transition from pediatric to adult health care services. They often experience a negative impact on their health with associated long-term health and social concerns, disease complications and increased use of emergency services once transitioned to adult services. This is particularly challenging for youth with cerebral palsy (CP) due the complexity of their medical needs. The aim of this study was to explore experiences with accessing or providing primary care services for transitioned-aged young adults with CP from young adult, parent, pediatrician and primary care physician perspectives.MethodsA qualitative descriptive design was conducted to identify the challenges and facilitators for transitioned aged young adults with accessing primary, adult care services. Semi-structured interviews were conducted with 16 participants within the circle of care (4 adults with CP, 4 parents, 4 pediatricians and 4 primary healthcare physicians) for individuals with CP in Toronto, Canada. Interviews were audio-recorded and transcribed verbatim. Qualitative analysis guided both the data collection and the data analysis processes.ResultsData analysis revealed that all participant groups reported transition challenges with respect to accessibility, the suitability of some primary care environments for caring for individuals with complex care needs, gaps in seamless care, and limited time and funding when receiving or providing primary care services to young adults with CP.DiscussionThere is a greater demand for adult healthcare providers now to deliver services for adults with childhood onset disabilities. Transition-aged young adults with CP and complex medical needs have increased challenges with accessing primary care services. Considering the following would improve primary care services transition for this population with complex medical needs: ongoing partnering between pediatric and adult health care streams to promote seamless care; connection to team-based primary care services where family physicians, subspecialties and interprofessional practitioners work together to provide joint care planning; salary compensation for increased service needs due to medical complexity; accessible sites; and development of guidelines for transitioning youth/young adults with complex care needs.

scholarly journals Development of a Research Tool to Document Self-Reported Chronic Conditions in Primary Care

2017 ◽  
Vol 7 (1) ◽  
pp. 117-123 ◽  
Author(s):  
Martin Fortin ◽  
José Almirall ◽  
Kathryn Nicholson
Keyword(s):  
Primary Care ◽  
Scoping Review ◽  
Chronic Conditions ◽  
Operational Definition ◽  
Research Tool ◽  
The Self ◽  
Care Services ◽  
Primary Care Services ◽  
The Impact ◽  
Research Studies

Background Researchers interested in multimorbidity often find themselves in the dilemma of identifying or creating an operational definition in order to generate data. Our team was invited to propose a tool for documenting the presence of chronic conditions in participants recruited for different research studies. Objective To describe the development of such a tool. Design A scoping review in which we identified relevant studies, selected studies, charted the data, and collated and summarized the results. The criteria considered for selecting chronic conditions were: (1) their relevance to primary care services; (2) the impact on affected patients; (3) their prevalence among the primary care users; and (4) how often the conditions were present among the lists retrieved from the scoping review. Results Taking into account the predefined criteria, we developed a list of 20 chronic conditions/categories of conditions that could be self-reported. A questionnaire was built using simple instructions and a table including the list of chronic conditions/categories of conditions. Conclusions We developed a questionnaire to document 20 self-reported chronic conditions/categories of conditions intended to be used for research purposes in primary care. Guided by previous literature, the purpose of this questionnaire is to evaluate the self-reported burden of multimorbidity by participants and to encourage comparability among research studies using the same measurement.

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