scholarly journals Characteristics of Neonatal Abstinence Syndrome (NAS) in a rural clinic population: Tracking with Electronic Medical Health Records (EHR)

2020 ◽  
Vol 20 (2) ◽  
pp. 194-212
Author(s):  
Jill D Cochran ◽  
Traci Jarrett ◽  
Adam Baus
Keyword(s):  
Health Care ◽  
High Risk ◽  
Health Care Providers ◽  
Age Groups ◽  
Primary Care Providers ◽  
Age Group ◽  
Care Providers ◽  
Rural Clinic ◽  
Age Related ◽  
High Risk Populations

PurposeThe impact of intrauterine exposure of opioids and other addictive substances on pediatric patients is concerning for health care providers in rural WV.  NAS patients must be identified, screened, and treated during the pediatric years to facilitate improved outcomes. The purpose of this research was to evaluate the ability of rural providers to use EHRs to identify, describe, and monitor aspects of NAS across the pediatric health span.  MethodsThe research team used de-identified data of patients that had the NAS diagnosis from a rural clinic. One hundred fifty-five charts were evaluated.  Demographics, clinical characteristics, and developmental milestone status were extracted from charts. ResultsThere were differences in characteristics across age groups. Reported secondhand smoke was higher among the 0-3 year olds. Normal BMI percentile was highest among 4-5 year olds.  The Ages and Stages Developmental screening was abnormal more in those aged 6-19 years. Foster care was highest among the ages 0-3 years. The 4-12 age groups highest amount of no show visits.  Respiratory illness was the most frequent diagnosis and was highest in the 4-5 age group.  Eye and ear diagnosis were noted as a recurrent diagnosis in the 4-5 year old group. Diagnosis related to mental health were highest in the 6-18 age group.  DiscussionThe EHR can be used to describe and track special populations such as NAS in rural areas. Tagging and tacking patients with NAS can help primary care providers manage care and anticipate age related health care needs. Tracking high risk populations assures that the patient care is maintained. Tracking no show rates assists providers in assuring that patient’s caregivers are compliant in necessary treatments and referrals. Child Protection can also be involved if medical neglect is noted. EHRs are useful in identifying high risk populations such as NAS to facilitate treatments and continuity of care.  DOI:  http://doi.org/10.14574/ojrnhc.v20i2.625 

scholarly journals SAT0640-HPR RHEUMATOLOGY CARE OF MIGRANTS FROM SUB-SAHARAN AFRICA; A QUALITATIVE PILOT STUDY OF PATIENTS’ PERSPECTIVES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1279.1-1279
Author(s):  
Z. Rutter-Locher ◽  
J. Galloway ◽  
H. Lempp
Keyword(s):  
Rheumatoid Arthritis ◽  
Health Care ◽  
Health Care Providers ◽  
Unmet Need ◽  
Primary Care Providers ◽  
Sub Saharan Africa ◽  
Care Providers ◽  
Specialist Care ◽  
Sub Saharan ◽  
The Uk

Background:Rheumatological diseases are common in Sub-Saharan Africa [1] but specialist healthcare is limited and there are less than 150 rheumatologists currently serving 1 billion people in Sub-Saharan Africa [2]. Rheumatologists practising in the UK NHS are likely to be exposed to migrant patients. There is therefore, an unmet need for health care providers to understand the differences in rheumatology healthcare provision between Sub-Saharan Africa and the UK and the barriers which migrants face in their transition of rheumatology care.Objectives:To gain an understanding of the experiences of patients with rheumatological conditions, about their past healthcare in Sub-Saharan Africa and their transition of care to the UK.Methods:A qualitative study using semi-structured interviews was conducted. Participants were recruited from two rheumatology outpatient clinics in London. Thematic analysis was applied to identify key themes.Results:Seven participants were recruited. Five had rheumatoid arthritis, one had ankylosing spondylitis and one had undifferentiated inflammatory arthritis. Participants described the significant impact their rheumatological conditions had on their physical and emotional wellbeing, including their social and financial implications. Compared to the UK, rheumatology healthcare in Sub-Saharan Africa was characterised by higher costs, limited access to specialists, lack of investigations and treatments, the use of traditional medicines and poor communication by clinicians. Barriers to transition of rheumatology care to the UK were: poor understanding of rheumatological conditions by the public and primary care providers, lack of understanding of NHS entitlements by migrants, fear of data sharing with immigration services and delayed referral to specialist care. Patient, doctor and public education were identified by participants as important ways to improve access to healthcare.Conclusion:This study has described, for the first time, patients’ perspectives of rheumatology health care in Sub-Saharan Africa and the transition of their care to the UK. These initial findings allow healthcare providers in the UK to tailor management for this migrant population and suggests that migrants need more information about their NHS entitlements and specific explanations on what non-clinical data will be shared with immigration services. To increase access to appropriate care, a concerted effort by clinicians and public health authorities is necessary to raise awareness and provide better education to patients and migrant populations about rheumatological conditions.References:[1]G. Mody, “Rheumatology in Africa-challenges and opportunities,” Arthritis Res. Ther., vol. 19, no. 1, p. 49, 2017.[2]M. A. M. Elagib et al., “Sudan and Sweden Active Rheumatoid Arthritis in Central Africa: A Comparative Study Between,” J. Rheumatol. J. Rheumatol. January, vol. 43, no. 10, pp. 1777–1786, 2016.Acknowledgments:We are grateful to the patients involved in this study for their time and involvement.Disclosure of Interests:None declared

scholarly journals Identifying and describing a model region to evaluate the impact of telemedicine

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
L Harst ◽  
S Oswald ◽  
P Timpel
Keyword(s):  
Health Care ◽  
Focus Group ◽  
Focus Groups ◽  
Health Care Providers ◽  
Rural Areas ◽  
Demographic Data ◽  
Care Providers ◽  
Age Related ◽  
Model Region ◽  
The Impact

Abstract Background Telemedicine solutions providing patient-centered care over distance need to be integrated into the regional setting. The acceptance by both providers and patients hat to be continuously evaluated using methods of participatory implementation research. In controlled trials, often taking place in laboratory settings, these methods cannot be applied. In the following, research in progress is presented. Methods Based on socio-demographic data, epidemiology prevalence of age-related chronic diseases and data on the value of health care provision in Saxony, Germany a model region was chosen. Then, a focus group (n = 6) was conducted to differentiate the results and analyze the health networks of patients. For this, network maps putting the individual in the middle and his/her sources of information and support in case of illness in concentric circles around it, were used. The focus group was audiotaped, transcribed and analyzed by two researchers using MaxQDA. Results With a mean age of 47.8 years (n = 17,431), high prevalence of diabetes (>15.85 %) and hypertension (>39.1%) and an expected shortage of primary physicians in 2030, the town of Kamenz is a mirror image of the current health care challenges in rural areas of Saxony. Participants of the focus groups also stated problems in finding a primary physician or a dentist. Compensatory behavior, such as traveling large distances, relying on self-researched online diagnoses and immediately going to the emergency room for medical support was described. According to the network maps, primary sources of support in case of illness are partners and relatives, yet there is little connection between those and health care providers, as well as between different medical specialists. Conclusions The results will lead to potential use cases of telemedicine to be included into a standardized questionnaire for the assessment of telemedicine readiness in the model region. Key messages Telemedicine implementation in a rural area can be studied using a participatory approach. Focus groups and network maps are useful qualitative methods for participatory research and can inform the design of quantitative measurements.

scholarly journals Worry from contracting COVID-19 infection and its stigma among Egyptian health care providers

2022 ◽  
Vol 97 (1) ◽  
Author(s):  
Doaa Mohamed Osman ◽  
Fatma R. Khalaf ◽  
Gellan K. Ahmed ◽  
Ahmed Y. Abdelbadee ◽  
Ahmed M. Abbas ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Health Care ◽  
High Risk ◽  
Health Care Providers ◽  
High Impact ◽  
Severe Illness ◽  
Care Providers ◽  
Internalized Shame ◽  
High Discrimination

Abstract Backgrounds Healthcare providers (HCPs) in COVID-19 epidemic face stressful workload of disease management, shortage of protective equipment and high risk of infection and mortality. These stressors affect greatly their mental health. The aim is to identify working conditions among Egyptian HCPs during COVID-19 epidemic as well as stigma and worry perceptions from contracting COVID-19 infection and their predictors. Methods A cross-sectional study was conducted among 565 HCPs. Data was collected through Google online self-administered questionnaire comprised seven parts: demographics characteristics, knowledge and attitude of COVID-19, working condition, worry of contracting COVID-19 at work, discrimination intention at work for COVID-19 patients, stigma assessment using impact stigma, and internalized shame scales. Results The vast majority of HCPs (94.7%) were worried from contracting COVID-19 at work. Risk factors for perceiving severe worry from contracting COVID-19 were expecting infection as a severe illness, believing that infection will not be successfully controlled, improbability to continue working during the pandemic even if in a well/fit health, high discrimination intention and impact stigma scales. Significantly high impact stigma scores were detected among those aged < 30 years, females, workers primarily in sites susceptible for contracting COVID-19 infection, those had severe worry from contracting infection at work, and high internalized shame scale. The risk factors for perceiving higher internalized shame scores were not having a previous experience in working during a pandemic, high discrimination intention towards COVID-19 patients and high impact stigma scale. Conclusions Considerable levels of worry and stigma were detected among Egyptian HCPs during COVID-19 outbreak. The psychological aspect of health care providers should not be overlooked during epidemic; appropriate institutional mental health support should be provided especially for young HCPs, those without previous work experience in epidemic and those who work in high-risk units. Raising the community awareness about contribution of HCPs in fighting the epidemic might decrease stigmatization action toward HCPs.

scholarly journals They Say, “If You Don’t Relax…You’re Going to Make Something Bad Happen”: Women’s Emotion Management During Medically High-Risk Pregnancy

2019 ◽  
Vol 44 (1) ◽  
pp. 117-129 ◽  
Author(s):  
Judith L. M. McCoyd ◽  
Laura Curran ◽  
Shari Munch
Keyword(s):  
Health Care ◽  
High Risk ◽  
Health Care Providers ◽  
Emotional Labor ◽  
Emotional Reactions ◽  
Emotion Management ◽  
High Risk Pregnancy ◽  
Care Providers ◽  
Risk Pregnancy ◽  
And Coping

Little is known about how women with medically high-risk pregnancy manage their emotions while worried about their pregnancies. This study aimed to phenomenologically explore 16 hospitalized women’s emotional reactions and coping during medically high-risk pregnancy with a focus on how emotion management techniques were utilized and what rationales women used for employing them, along with their interpretations of health care providers’ and family members’ advice regarding emotional expression. Respondents universally feared that experienced stress and the resulting distress (negative emotions such as anxiety, sadness, and anger) could harm their fetus. They experienced double binds including believing they must “be positive” to enhance fetal health, despite anxiety and sadness; feeling responsible for housework yet being told not to do it; and needing medical treatments they feared would harm their fetus. In attempting to avoid tears and fears, they expended tremendous energy, leaving themselves depleted and less able to cope. Ubiquitous “think positive” messages amplify women’s sense of failure when distress due to the medically high-risk pregnancy spills over. With little attention to women’s emotional experiences, even to the point of complimenting them as “good incubators,” health care providers may unintentionally shift emotional labor onto vulnerable women. Understanding women’s needs for assistance with emotion management during medically high-risk pregnancy provides important guidance for development of best practices for this population.

scholarly journals An Epigenetics-Based, Lifestyle Medicine–Driven Approach to Stress Management for Primary Patient Care: Implications for Medical Education

2019 ◽  
Vol 14 (3) ◽  
pp. 294-303 ◽  
Author(s):  
Jenny Lee ◽  
Frank Papa ◽  
Paresh Atu Jaini ◽  
Sarah Alpini ◽  
Tim Kenny
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Patient Care ◽  
Stress Management ◽  
Health Care Providers ◽  
Primary Care Providers ◽  
Therapeutic Interventions ◽  
Care Providers ◽  
Lifestyle Medicine ◽  
Lifestyle Choices

Over 75% of patients in the primary care setting present with stress-related complaints. Curiously, patients and health care providers all too often see stress as a relatively benign sequela of many common illnesses such as heart disease, cancer, lung disease, dementia, diabetes, and mental illness. Unfortunately, various day-to-day lifestyle choices and environmental factors, unrelated to the presence of any disease, can cause stress sufficient to contribute to the development of various diseases/disorders and suboptimal health. There is evidence suggesting that counseling in stress management–oriented therapeutic interventions (as offered by lifestyle medicine–oriented practitioners) may prevent or reduce the onset, severity, duration, and/or overall burden of stress-related illnesses. Such counseling often involves considerations such as the patient’s nutrition, physical activity, interest in/capacity to meditate, drug abuse/cessation, and so on. Unfortunately, lifestyle medicine–oriented approaches to stress management are rarely offered in primary care—the patient care arena wherein such counseling would likely be best received by patients. Would health care outcomes improve if primary care providers offered counseling in both stress management and positive lifestyle choices? The purpose of this article is to provide both primary care practitioners and educators in health care training programs with an introductory overview of epigenetics. An emerging field of science offering insights into how factors such as stress and lifestyle choices interact with our genes in ways that can both positively and negatively impact the various micro (eg, cellular) through macro (eg, physiologic, pathophysiologic) processes that determine our tendencies toward illness or wellness. A deeper understanding of epigenetics, as provided herein, should enable primary care providers and medical educators to more confidently advocate for the primary benefits associated with counseling in both stress reduction and the pursuit of healthy lifestyle choices.

scholarly journals The needs of Pacific families affected by age-related cognitive impairment in New Zealand: interviews with providers from health-care organisations

2021 ◽  
Vol 13 (4) ◽  
pp. 317
Author(s):  
Vanda Symon ◽  
Rosalina Richards ◽  
Pauline Norris ◽  
Talai Mapusua ◽  
Leigh Hale
Keyword(s):  
Health Care ◽  
Cognitive Impairment ◽  
New Zealand ◽  
Cognitive Decline ◽  
Health Care Providers ◽  
Service Providers ◽  
Care Providers ◽  
Access To Services ◽  
Age Related ◽  
Poor Access

ABSTRACTINTRODUCTIONPacific populations in New Zealand are aging, but little is known in the health-care environment about their experiences with cognitive impairment.AIMThe aim was to explore the needs of Pacific peoples affected by age-related cognitive decline from the perspectives of health-care providers.METHODSSix health-care service providers from organisations focused on Pacific patients were interviewed to determine services available to aged Pacific peoples, access, and whether they met Pacific people’s needs.RESULTSThree areas of concern were identified by all participants: access to services; getting a diagnosis; and communication and language. Many experienced a lack of information and poor access to services. Diagnosis of cognitive impairment was frequently made difficult by inconsistent access to general practitioners in lower socio-economic areas. Communication was hindered by poor access to information in Pacific languages.DISCUSSIONCommon themes noted by all participating health-care providers indicated the needs of aged Pacific people experiencing cognitive decline were often not being met.

scholarly journals A Systems-Wide Approach for Early Detection and Management of Dementia in Primary Care

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 346-346
Author(s):  
Annette Fitzpatrick ◽  
Basia Belza
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Providers ◽  
Signs And Symptoms ◽  
Primary Care Providers ◽  
Population Increase ◽  
Community Advisory Board ◽  
Care Practice ◽  
Care Providers ◽  
Cognitive Changes

Abstract Dementia is frequently unrecognized and under-reported by health care providers. The needs of an aging population increase the burden on an already over-worked primary care system that is often without the appropriate training, resources, and reimbursement to address the growing number of people with cognitive decline in the US. In this symposium we present a systems-wide approach within University of Washington (UW) Primary Care to increase awareness of early signs and symptoms, detection of cognitive impairment, and support of providers, patients and caregivers that will ultimately improve outcomes of care. This quality improvement (QI) program integrates stakeholder-selected components of the GSA KAER (Kickstart-Assess-Evaluate and Refer) Model and Toolkit (2020 Edition), developed by the Gerontological Society of America (GSA), into primary care practice. We describe content and logistics of a continuing education intervention for primary care providers and clinical staff to increase skills for evaluation and management of dementia. Working with UW clinic managers and information technology (IT), we have developed a pragmatic system for streamlining operations and documenting care utilizing newly developed interdisciplinary workflows and electronic health record order sets. Using input from our Community Advisory Board, we explain development of a web-based resource directory to be used in-clinic and at home to support providers, staff, patients, families, and caregivers across cognitive changes. Strategies presented here are aimed to help other health care systems initiate steps to integrate KAER and other tools into a practical QI program for improving detection and management of dementia through support of primary care.

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