scholarly journals PRACTICES OF HOSPITAL NURSES FOR CONTINUITY OF CARE IN PRIMARY CARE: AN EXPLORATORY STUDY

2021 ◽  
Vol 30 ◽  
Author(s):  
Maria Fernanda Baeta Neves Alonso da Costa ◽  
Esperanza I. Ballesteros Perez ◽  
Suely Itsuko Ciosak
Keyword(s):  
Primary Care ◽  
Continuity Of Care ◽  
Structured Interview ◽  
Hospital Nurses ◽  
Management Service ◽  
University Hospitals ◽  
Care Needs ◽  
Post Discharge ◽  
Discharge Care ◽  
Director Of Nursing

ABSTRACT Objective: to know the practices developed by hospital nurses for continuity of care for Primary Care. Method: this is an exploratory, qualitative research conducted in university hospitals in São Paulo and Curitiba, Brazil. For data collection, a semi-structured interview was conducted with the Director of Nursing and an online questionnaire through open-ended and closed-ended questions, with nurses between August 2018 and July 2019. The analyzes of the interviews were carried out as proposed by Minayo based on in the theoretical framework of continuity of care. Results: the research was conducted at three university hospitals, and one Director of Nursing and 48 nurses participated. From analysis of nurses’ answers, two categories of analysis emerged: identification of post-discharge patients’ care needs and the necessary competencies for continuity of care. Where it was perceived since patients’ admission, nurses’ concern for continuity of post-hospital discharge care, establishing flows together with nurses of the Internal Center for Regulation/Discharge Management Service for the Health Department of the municipality, which forwards to patients’ reference health unit. Conclusion: although nurses are professionals who actively participates in care at various points in the health care network and recognizes the importance of continuing post-discharge care, they remain a fragile point in the care chain, and it is necessary to strengthen this mechanism with Primary Care, optimize home care and avoid hospitalizations.

scholarly journals CONTINUITY OF HOSPITAL DISCHARGE CARE FOR PRIMARY HEALTH CARE: SPANISH PRACTICE

2020 ◽  
Vol 29 ◽  
Author(s):  
Maria Fernanda Baeta Neves Alonso da Costa ◽  
Suely Itsuko Ciosak ◽  
Selma Regina de Andrade ◽  
Cilene Fernandes Soares ◽  
Esperanza I. Ballesteros Pérez ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Hospital Discharge ◽  
Continuity Of Care ◽  
University Hospitals ◽  
Online Questionnaire ◽  
Primary Health ◽  
Discharge Care ◽  
Discharge Plan

ABSTRACT Objective: to understand discharge plan and the facilities and difficulties for continuity of care in Primary Health Care. Method: a qualitative and exploratory study carried out in Madrid, Barcelona, Murcia, Seville and Granada, with 29 hospital liaison nurses working in university hospitals, between 2016 and 2018. For data collection, an online questionnaire was used with open and closed questions about the profile of nurses; work context; hospital discharge plan; communication between hospital nurses and primary care. All were analyzed based on Thematic Analysis. Results: hospital liaison nurses from Spain draw up a discharge plan at least 48 hours in advance. They offer a Continuity of Care Report, guide patients, families and caregivers to the necessary care after hospital discharge, coordinate consultations and referrals and carry out home visits. Communication with primary care occurs through the computerized system and telephone. Monitoring takes place using indicators and statistical reports. In cases of readmission, nurses are requested and contacted by nurses in primary care. Communication with primary care is among the facilities. Lack of liaison nurses is among the difficulties. Conclusion: hospital liaison nurses from Spain carry out a discharge plan and communicate with primary care. When patients are hospitalized, they are called when there is a need for continuity of care for primary care.

Optimization of Provider Ecosystem Through Actor-Resource Integration

2020 ◽  
pp. 103-115
Author(s):  
Mohan Tanniru
Keyword(s):  
Information Technology ◽  
Social Media ◽  
Continuity Of Care ◽  
Healthcare Providers ◽  
Care Transition ◽  
The Internet ◽  
Post Discharge ◽  
Discharge Care ◽  
Internal Operations ◽  
Insight Into

Information technology has enabled healthcare providers such as hospitals to extend their internal operations into external facilities such as urgent and ambulatory care centers and optimizeresources in support of patient care. With the development of the internet, social media, wearables, and telehealth technologies, the potential for patient engagement in preventive and post-discharge care transition has increased. Unlike other organizations where the provider has limited insight into the customer ecosystem, hospitals, for example, have an opportunity to gain insight into the patient ecosystem and influence patient behavior while the patients are within the provider ecosystem. This chapter looks at hospital engagement with patients in two settings—the emergency room (ER) and the patient room (PR)—to illustrate both the opportunities and the strategies that can help hospitals use patient touchpoints to improve continuity of care inside and outside hospital walls.

scholarly journals CARE TRANSTION IN HOSPITAL DISCHARGE FOR ADULT PATIENTS: INTEGRATIVE LITERATURE REVIEW

2021 ◽  
Vol 30 ◽  
Author(s):  
Jociele Gheno ◽  
Alísia Helena Weis
Keyword(s):  
Hospital Discharge ◽  
Continuity Of Care ◽  
Care Transitions ◽  
Hospital Costs ◽  
Experimental Studies ◽  
Adult Patients ◽  
Care Transition ◽  
Discharge Process ◽  
Post Discharge ◽  
Discharge Care

ABSTRACT Objective: to summarize and analyze the scientific production on care transition in the hospital discharge of adult patients. Method: integrative review, conducted from May to July 2020, in four relevant databases in the health area: Public Medline (PubMed); Scientific Electronic Library Online (SciELO); Scopus and Virtual Health Library (VHL). The analysis of the results occurred descriptively and was organized into thematic categories that emerged according to the similarity of the contents extracted from the articles. Results: 46 articles from national and international journals, with a predominance of descriptive/non-experimental studies or qualitative studies, met the inclusion criteria. Five categories were identified: discharge and post-discharge process; Continuity of post-discharge care; Benefits of care transition; Role of nurses in care transition and Experiences of patients on care transition. Hospital discharge and care transitions are interconnected processes as transitions qualify the dehospitalization process. Different strategies for continuity of care should be adopted, as they offer greater safety to the patient. Studies have shown that nurses play a fundamental role in transitions and, in Brazil, this activity still needs to gain more space. Reduced hospitalizations, mortality, hospital costs and patient satisfaction are benefits of transitions. Conclusion: care transition is an effective strategy for the care provided to the patient being discharged. It points out the need for integration between the care network and assists services in decision-making about the continuity of care on discharge.

scholarly journals Family Caregivers on the Frontline: Challenges of Providing Care to Post-ICU COVID-19 Patients

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 946-946
Author(s):  
Amanda Leggett ◽  
Alicia Carmichael ◽  
Natalie Leonard ◽  
Sheria Robinson-Lane ◽  
Sophia Li ◽  
...  
Keyword(s):  
Family Caregivers ◽  
Qualitative Interviews ◽  
Critical Role ◽  
Contact Fatigue ◽  
Well Being ◽  
Care Providers ◽  
Care Needs ◽  
Post Discharge ◽  
Discharge Care ◽  
Knowledge Deficits

Abstract Family caregivers are essential care providers helping to ensure the sometimes complicated recovery of recently hospitalized COVID-19 patients. COVID-19 caregivers face pandemic-specific challenges such as not being at patient bedside throughout the hospital stay and managing social distancing post-discharge. The current study aims to explore the unique experiences of family caregivers of Intensive Care Unit (ICU) COVID-19 patients. In-depth qualitative interviews were conducted by web conference with 13 dyads of adults who were in an ICU for COVID-19 between March and August 2020 and their primary caregiver (n=26). Participants were interviewed about the care recipient’s hospitalization and recovery journey, supports received, challenges experienced, and gaps in the system of care. Thematic qualitative analysis was conducted utilizing Watkins’ (2017) rigorous and accelerated data reduction (RADaR) technique. Caregivers played a critical role in patient admission, discharge, and recovery. Themes of caregiving challenges included self-management of COVID-19 infection, knowledge deficits of available resources and post-discharge care needs, post-infection stigma, separation guilt, deprioritized self-care, financial challenges, and lengthy recoveries with some ongoing health needs. While receipt of emotional support was considered an advantage, some caregivers expressed contact fatigue. Understanding how COVID caregivers experience illness management across the recovery journey can aid our understanding of the COVID caregiving process and identify intervention targets to improve overall health and well-being of the care dyad.

scholarly journals Out-of-Pocket Spending for Health Care Within 90 Days of COVID-19 Hospitalization

2021 ◽  
Author(s):  
Kao-Ping Chua ◽  
Rena M Conti ◽  
Nora V Becker
Keyword(s):  
Health Care ◽  
Private Insurance ◽  
Health Care Needs ◽  
Medicare Advantage ◽  
Care Needs ◽  
Post Discharge ◽  
Cross Sectional ◽  
Discharge Care ◽  
Sectional Analysis ◽  
Privately Insured

INTRODUCTION: Millions of U.S. patients have been hospitalized for coronavirus disease 2019 (COVID-19). After discharge, these patients often have extensive health care needs, but out-of-pocket burden for this care is poorly described. Using national data, we assessed out-of-pocket spending during the 90 days after COVID-19 hospitalization among privately insured and Medicare Advantage patients. METHODS: In May 2021, we conducted a cross-sectional analysis of the IQVIA PharMetrics Plus for Academics Database, a national de-identified claims database. Among privately insured and Medicare Advantage patients hospitalized for COVID-19 between March-June 2020, we calculated mean out-of-pocket spending for care within 90 days of discharge. To contextualize results, we repeated analyses for patients hospitalized for bacterial pneumonia. RESULTS: Among 1,465 COVID-19 patients included, 516 (35.2%) and 949 (64.8%) were covered by private insurance and Medicare Advantage plans. Among these patients, mean (SD) post-discharge out-of-pocket spending was $534 (1,045) and $680 (1,360); spending exceeded $2,000 for 7.0% and 10.3%. Compared with patients with pneumonia, mean post-discharge out-of-pocket spending among COVID-19 patients was higher among the privately insured ($534 vs $445) and lower among Medicare Advantage patients ($680 vs $918). CONCLUSIONS: Out-of-pocket spending for immediate post-discharge care can be substantial for many patients hospitalized for COVID-19. Among Medicare Advantage patients, post-discharge out-of-pocket spending was higher after pneumonia hospitalizations, potentially because insurer cost-sharing waivers fully covered the costs of COVID-19-related readmissions during the study period. As many insurers allowed such waivers to expire in 2021, it is important to repeat analyses among patients more recently hospitalized for COVID-19.

scholarly journals Implementing post-discharge care following acute kidney injury in England: a single-centre qualitative evaluation

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e036077 ◽  
Author(s):  
Rebecca Elvey ◽  
Susan J Howard ◽  
Anne-Marie Martindale ◽  
Thomas Blakeman
Keyword(s):  
Primary Care ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Transitions Of Care ◽  
Clinical Expertise ◽  
Structured Interviews ◽  
Post Discharge ◽  
Factors Influencing ◽  
Discharge Care ◽  
Discharge Summaries

ObjectivesWe sought to understand the factors influencing the implementation of a primary care intervention to improve post-discharge care following acute kidney injury (AKI).DesignQualitative study using semi-structured interviews and thematic analysis.SettingGeneral practices in one Clinical Commissioning Group area in England.ParticipantsA total of 18 healthcare staff took part in interviews. Participants were practice pharmacists, general practitioners, practice managers and administrators involved in implementing the intervention.ResultsWe identified three main factors influencing implementation: differentiation of the new intervention from other practice work; development of skill mix and communication across organisations. Overall, post-AKI processes of care were deemed straightforward to embed into existing practice. However, it was also important to separate the intervention from other work in general practice. Dedicating staff time to proactively identify AKI on discharge summaries and to coordinate the provision of care enabled implementation of the intervention. The post-AKI intervention provided an opportunity for practice pharmacists to expand their primary care role. Working in a new setting also brought challenges; time to develop trusting relationships including an understanding of boundaries of clinical expertise influenced pharmacists’ roles. Unclear and inconsistent information on discharge summaries contributed to concerns about additional work in primary care.ConclusionsThe research highlights challenges around post-discharge management in the primary care context. Coordination and communication were key factors for improving follow-up care following AKI. Further consideration is required to understand patient experiences of the interface between secondary and primary care. The issues pertaining to discharge care following AKI are relevant to practitioners and commissioners as they work to improve transitions of care for vulnerable patient populations.

scholarly journals Professional training in physiotherapy: primary care practices

2020 ◽  
Vol 33 ◽  
Author(s):  
Luciana Tavares Ferreira ◽  
Fátima Ferretti ◽  
Carla Rosane Paz Arruda Teo ◽  
Hedioneia Maria Foletto Pivetta
Keyword(s):  
Primary Care ◽  
Home Health Care ◽  
Professional Training ◽  
Community Integration ◽  
Care Home ◽  
Structured Interview ◽  
Care Needs ◽  
Santa Catarina ◽  
Waiting Room ◽  
Santa Catarina State

Abstract Introduction: Professional training in physiotherapy still focuses primarily on rehabilitation; however, there is a need to ensure that these professionals are also equipped to work in primary care (PC), since it is the gateway to the healthcare system. Objective: Identify practices carried out in PC by undergraduate physiotherapy courses in Santa Catarina state, Brazil, from the perspective of professors. Method: Qualitative study with a multiple-case design. All eight undergraduate physiotherapy courses available in the state were included as cases in this study. Five physiotherapy professors also took part as key informants (KIs) Data were collected by document analysis of course pedagogical projects (CPPs) and a semi-structured interview regarding training practices conducted in primary care (PC) settings. Data were analyzed using thematic analysis. Results: Based on content analysis of the interviews, practices carried out in PC by the different courses include territorialization; specific group activities; home health care/home visits; postural education in school settings; interdisciplinary and multiprofessional experiences; interviews; waiting room activities; combined consultations and singular therapeutic projects. Conclusion: practices performed in primary care facilities by undergraduate physiotherapy courses in Santa Catarina state (SC), Brazil, are aimed at meeting primary care needs; however, teaching-service-community integration is essential in order to diversify these PC experiences throughout the training process and expand interdisciplinary and multiprofessional activities.

scholarly journals Understanding the clinical reasoning processes involved in the management of multimorbidity in an ambulatory setting: study protocol of a stimulated recall research

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
M.-C. Audétat ◽  
S. Cairo Notari ◽  
J. Sader ◽  
C. Ritz ◽  
T. Fassier ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Reasoning ◽  
Primary Care Physicians ◽  
Video Sequence ◽  
Structured Interview ◽  
Ambulatory Setting ◽  
Structured Interviews ◽  
Stimulated Recall ◽  
Study Results

Abstract Background Primary care physicians are at the very heart of managing patients suffering from multimorbidity. However, several studies have highlighted that some physicians feel ill-equipped to manage these kinds of complex clinical situations. Few studies are available on the clinical reasoning processes at play during the long-term management and follow-up of patients suffering from multimorbidity. This study aims to contribute to a better understanding on how the clinical reasoning of primary care physicians is affected during follow-up consultations with these patients. Methods A qualitative research project based on semi-structured interviews with primary care physicians in an ambulatory setting will be carried out, using the video stimulated recall interview method. Participants will be filmed in their work environment during a standard consultation with a patient suffering from multimorbidity using a “button camera” (small camera) which will be pinned to their white coat. The recording will be used in a following semi-structured interview with physicians and the research team to instigate a stimulated recall. Stimulated recall is a research method that allows the investigation of cognitive processes by inviting participants to recall their concurrent thinking during an event when prompted by a video sequence recall. During this interview, participants will be prompted by different video sequence and asked to discuss them; the aim will be to encourage them to make their clinical reasoning processes explicit. Fifteen to twenty interviews are planned to reach data saturation. The interviews will be transcribed verbatim and data will be analysed according to a standard content analysis, using deductive and inductive approaches. Conclusion Study results will contribute to the scientific community’s overall understanding of clinical reasoning. This will subsequently allow future generation of primary care physicians to have access to more adequate trainings to manage patients suffering from multimorbidity in their practice. As a result, this will improve the quality of the patient’s care and treatments.

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