The Registered Dietitian in Primary Care: The Hamilton Experience

2007 ◽  
Vol 68 (2) ◽  
pp. 81-85 ◽  
Author(s):  
Wendy Gamblen ◽  
Sherri Schamehorn ◽  
Anne Marie Crustolo ◽  
Tracy Hussey ◽  
Nick Kates ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Interdisciplinary Collaboration ◽  
Community Services ◽  
Care Providers ◽  
Clinical Role ◽  
Nutrition Services ◽  
Wide Range ◽  
Canadian Health ◽  
Shared Care Model

The Hamilton Health Service Organization Nutrition Program integrates nine registered dietitians (RDs) into the offices of 80 family physicians (FPs) at 50 sites in Hamilton, Ontario. The program is based on a shared care model, in which FPs and RDs work collaboratively to provide nutrition services aimed at prevention, treatment, and management of nutrition-related problems. In addition to their clinical role, dietitians in the program are involved in health promotion, disease prevention and early intervention strategies, interdisciplinary collaboration, building links with community services, and research. The RDs’ specialized knowledge, skills, and experience allow them to provide a wide range of services that complement and augment those of the FP. This model is consistent with Canadian health care reform recommendations and offers significant benefits for both health care providers and consumers.

Nutrition in Primary Health Care: Using a Delphi Process To Design New Interdisciplinary Services

2006 ◽  
Vol 67 (S1) ◽  
pp. S14-S29 ◽  
Author(s):  
Paula Brauer ◽  
Linda Dietrich ◽  
Bridget Davidson ◽  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Providers ◽  
Administrative Support ◽  
Care Service ◽  
Delphi Process ◽  
Care Providers ◽  
Modified Delphi ◽  
Nutrition Services ◽  
Key Features

Purpose: A modified Delphi process was used to identify key features of interdisciplinary nutrition services, including provider roles and responsibilities for Ontario Family Health Networks (FHNs), a family physician-based type of primary care. Methods: Twenty-three representatives from interested professional organizations, including three FHN demonstration sites, completed a modified Delphi process. Participants reviewed evidence from a systematic literature review, a patient survey, a costing analysis, and key informant interview results before undertaking the Delphi process. Statements describing various options for services were developed at an in-person meeting, which was followed by two rounds of e-mail questionnaires. Teleconference discussions were held between rounds. Results: An interdisciplinary model with differing and complementary roles for health care providers emerged from the process. Additional key features addressing screening for nutrition problems, health promotion and disease prevention, team collaboration, planning and evaluation, administrative support, access to care, and medical directives/delegated acts were identified. Under the proposed model, the registered dietitian is the team member responsible for managing all aspects of nutrition services, from needs assessment to program delivery, as well as for supporting all providers’ nutrition services. Conclusions: The proposed interdisciplinary nutrition services model merits evaluation of cost, effectiveness, applicability, and sustainability in team-based primary care service settings.

League Tables for Performance Improvement in Health Care

1998 ◽  
Vol 3 (1) ◽  
pp. 50-57 ◽  
Author(s):  
Sandra Nutley ◽  
Peter C. Smith
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Analytical Techniques ◽  
Performance Data ◽  
Future Research ◽  
League Table ◽  
Care Providers ◽  
League Tables ◽  
Wide Range ◽  
The Impact

Objectives: Increasingly health care performance data are being disseminated in the form of ‘league tables' of health care providers, with the implication that such publication helps purchasers select the better providers, and spurs providers into improvements. This paper examines progress to date. Methods: Three stages of the league table process are considered: measurement, analysis and action. Results: A wide range of measurement schemes are now in place, although the emphasis has been on process variables and mortality as a measure of outcome. Several analytical techniques have been deployed to help users make sense of league tables, and to help determine the causes of variations in reported performance. The weakest aspect of current methods relates to the use to which such analysis is put. Conclusions: A haphazard approach to using league table data exists, with few reports on the impact of publication. A variety of directions for future research into the use of performance data are needed.

Intrauterine Contraception: Knowledge and Prescribing Practices of Canadian Health Care Providers

2019 ◽  
Vol 41 (8) ◽  
pp. 1084-1092 ◽  
Author(s):  
Jocelynn Cook ◽  
Ashley Waddington ◽  
Denise Black ◽  
Dustin Costescu ◽  
Danica Desjardins ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Care Providers ◽  
Prescribing Practices ◽  
Intrauterine Contraception ◽  
Canadian Health ◽  
Canadian Health Care

scholarly journals Canadian recommendations for the management of breakthrough cancer pain

2016 ◽  
Vol 23 (2) ◽  
pp. 96 ◽  
Author(s):  
P. Daeninck ◽  
B. Gagnon ◽  
R. Gallagher ◽  
J.D. Henderson ◽  
Y. Shir ◽  
...  
Keyword(s):  
Health Care ◽  
Cancer Pain ◽  
Health Care Providers ◽  
Immediate Release ◽  
Care Providers ◽  
Onset Of Action ◽  
Breakthrough Cancer Pain ◽  
Appropriate Treatment ◽  
Canadian Health ◽  
Canadian Health Care

Breakthrough cancer pain (btcp) represents an important element in the spectrum of cancer pain management. Because most btcp episodes peak in intensity within a few minutes, speed of medication onset is crucial for proper control. In Canada, several current provincial guidelines for the management of cancer pain include a brief discussion about the treatment of btcp; however, there are no uniform national recommendations for the management of btcp. That lack, accompanied by unequal access to pain medication across the country, contributes to both regional and provincial variability in the management of btcp.Currently, immediate-release oral opioids are the treatment of choice for btcp. This approach might not always offer optimal speed for onset of action and duration to match the rapid nature of an episode of btcp. Novel transmucosal fentanyl formulations might be more appropriate for some types of btcp, but limited access to such drugs hinders their use. In addition, the recognition of btcp and its proper assessment, which are crucial steps toward appropriate treatment selection, remain challenging for many health care professionals.To facilitate appropriate management of btcp, a group of prominent Canadian specialists in palliative care, oncology, and anesthesiology convened to develop a set of recommendations and suggestions to assist Canadian health care providers in the treatment of btcp and the alleviation of the suffering and discomfort experienced by adult cancer patients.

scholarly journals What Do Patients Complain About Online: A Systematic Review and Taxonomy Framework Based on Patient Centeredness (Preprint)

2019 ◽  
Author(s):  
Jing Liu ◽  
Shengchao Hou ◽  
Richard Evans ◽  
Chenxi Xia ◽  
Weidong Xia ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
A Priori ◽  
Patient Experiences ◽  
Study Patient ◽  
Significant Heterogeneity ◽  
Care Providers ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Wide Range

BACKGROUND Complaints made online by patients about their health care experiences are becoming prevalent because of widespread worldwide internet connectivity. An a priori framework, based on patient centeredness, may be useful in identifying the types of issues patients complain about online across multiple settings. It may also assist in examining whether the determinants of patient-centered care (PCC) mirror the determinants of patient experiences. OBJECTIVE The objective of our study was to develop a taxonomy framework for patient complaints online based on patient centeredness and to examine whether the determinants of PCC mirror the determinants of patient experiences. METHODS First, the best fit framework synthesis technique was applied to develop the proposed a priori framework. Second, electronic databases, including Web of Science, Scopus, and PubMed, were searched for articles published between 2000 and June 2018. Studies were only included if they collected primary quantitative data on patients’ online complaints. Third, a deductive and inductive thematic analysis approach was adopted to code the themes of recognized complaints into the framework. RESULTS In total, 17 studies from 5 countries were included in this study. Patient complaint online taxonomies and theme terms varied. According to our framework, patients expressed most dissatisfaction with patient-centered processes (101,586/204,363, 49.71%), followed by prerequisites (appropriate skills and knowledge of physicians; 50,563, 24.74%) and the care environment (48,563/204,363, 23.76%). The least dissatisfied theme was expected outcomes (3651/204,363, 1.79%). People expressed little dissatisfaction with expanded PCC dimensions, such as involvement of family and friends (591/204,363, 0.29%). Variation in the concerns across different countries’ patients were also observed. CONCLUSIONS Online complaints made by patients are of major value to health care providers, regulatory bodies, and patients themselves. Our PCC framework can be applied to analyze them under a wide range of conditions, treatments, and countries. This review has shown significant heterogeneity of patients’ online complaints across different countries.

scholarly journals Canadian Consensus Guidelines for the Optimal Use of Maraviroc in the Treatment of HIV-Infected Adults

2010 ◽  
Vol 21 (4) ◽  
pp. 159-172 ◽  
Author(s):  
Anita Rachlis ◽  
Marianne Harris ◽  
Richard Lalonde ◽  
Stephen D Shafran ◽  
Cécile Tremblay ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Hiv Treatment ◽  
Care Providers ◽  
Expert Opinions ◽  
Hiv Management ◽  
Conference Presentations ◽  
Canadian Health ◽  
Canadian Health Care ◽  
Group Members

BACKGROUND AND OBJECTIVES: A Canadian group, consisting of six physicians and an HIV researcher with significant experience and knowledge in HIV management, reviewed the available data and developed guidelines for Canadian health care providers (who treat HIV infection) on the appropriate use of maraviroc (UK-427,857) in HIV-infected adults.METHODS: Evidence from the published literature and conference presentations, as well as the expert opinions of the group members were considered and evaluated to develop the recommendations. Feedback on the draft recommendations was obtained from this core group, as well as from four other physicians across Canada with expertise in HIV treatment and experience with the use of maraviroc. The final recommendations represent the core group’s consensus agreement once all feedback was considered.RESULTS/CONCLUSIONS: Recommendations were developed to guide physicians and other health care providers in the optimal use of maraviroc. The recommendations were considered in light of the fact that the decision to include maraviroc in an antiretroviral regimen depends not only on issues that concern all antiretroviral agents, such as efficacy, safety, resistance and drug interactions, but also on the issue of viral tropism, which is unique to maraviroc and other CCR5 inhibitors.

Four Meanings of Medicalization: Childbirth as a Case study

2009 ◽  
pp. 123-141
Author(s):  
Wendy Christiaens ◽  
Edwin van Teijlingen
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Interdisciplinary Collaboration ◽  
Medical Knowledge ◽  
Medical Model ◽  
Medical Discourse ◽  
Care Providers ◽  
Sociological Approach ◽  
Conceptual Clarity ◽  
Social Scientific

- Medicalisation is a commonly used and ‘easily' understood concept among health care providers and researchers as well as in popular culture, but it is contested within medical sociology. This paper distinguishes between four meanings bestowed on medicalisation to enhance its conceptual clarity, using the example of childbirth as an illustration. Within the first generation of medicalisation theory, largely covering the ideas of Freidson, Conrad and Illich, we distinguish between three layers of meaning: (a) the origin of the medical model; (b) medical imperialism; and (c) iatrogenesis. The first meaning refers to the origin of the medical knowledge. In the second meaning daily life becomes increasingly defined in terms of health and illness, hence incorporating a growing number of life domains and social problems. The power of the medical discourse and the associated social control are central issues. The third meaning is represented by the critical or conflict sociological approach, in which medicalisation is interpreted as an exaggeration of medical control, hence emphasising its iatrogenic (‘sick-making') effects. The second generation medicalisation theory addresses a changed and more complex organisation of health care. New medicalisation tendencies surpass the old ones, adding a new layer of meanings to the concept: the optimalisation of normal characteristics or processes. Hence, normal phenomena become problematic and a new consuming market is created. A key message from our paper is that poor conceptualisation of medicalisation as an analytical tool endangers the quality and comparability of social scientific research and interdisciplinary collaboration.Keywords: medicalization, birth, iatrogenesis, medical imperialism, sociology of health, health care.Parole chiave: medicalizzazione, parto, iatrogenesi, imperialismo medico, sociologia della salute, assistenza sanitaria.

scholarly journals The practice and teaching of palpation of the head and neck: A scoping review

2017 ◽  
Vol 7 (12) ◽  
pp. 20
Author(s):  
Epstein I. ◽  
Herne P. ◽  
Masita S. ◽  
Peisachovich E. ◽  
De Silva C. ◽  
...  
Keyword(s):  
Health Care ◽  
Head And Neck ◽  
Interpersonal Relationships ◽  
Health Care Providers ◽  
Scoping Review ◽  
Interdisciplinary Collaboration ◽  
Vital Role ◽  
Care Providers ◽  
Physical Assessment ◽  
Ultrasound Technology

Objective: To explore how palpation of the head and neck is practiced and taught.Methods: The scoping review methodology was guided by Arksey and O’Malley’s five-stage approach. Three experienced and independent reviewers searched nine databases according to a predetermine inclusion and exclusion criteria.Results: A total of 15 articles from medicine, chiropractic and dentistry published between 1987 and 2016 were included. Two overarching themes emerged, a Cartesian and a Pragmatic perspective in practicing and teaching palpating of the head and neck. Although both perspectives are valuable, we advocate to practice and teach palpation of head and neck from a Pragmatic perspective particularly with the increase use of ultrasound technology to detect masses. A pragmatic perspective takes into account the patient’s context, the ethics of care and highlights the importance of health care providers fostering interpersonal relationships with others during physical assessment.Conclusions: Although nursing studies were absent from this review we believe nurses play a vital role when they are aware of the Cartesian and Pragmatics perspectives when practicing and teaching head and neck palpation as part of a physical assessment. Learning how other disciplines are practicing and teaching head and neck palpation skills will improve interdisciplinary collaboration. 

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