scholarly journals Impact of Pharmacist Care in a Shared Medical Appointment Model for the Management of Type 2 Diabetes in a Micronesian Population

2014 ◽  
Vol 12 (2) ◽  
pp. 13-21
Author(s):  
Candace Tan ◽  
Deborah T. Juarez ◽  
Stacy Haumea ◽  
Charlotte Grimm
Keyword(s):  
Health Care ◽  
Clinical Pharmacy ◽  
Standard Care ◽  
The United States ◽  
Pacific Islanders ◽  
Management Service ◽  
Medical Appointment ◽  
Shared Medical Appointment ◽  
Significant Difference ◽  
Pharmacist Care

More than 25 million people have diabetes in the United States and its complications make it a leading cause of death. Pacific Islanders, specifically Micronesians, experience even higher rates of diabetes, and pharmacist care for these individuals may improve health outcomes. Objective: To better address health disparities in this population, a health center serving Hawaii Island added clinical pharmacy services into their shared medical appointment program for diabetes management. Methods: Standard care (n= 21) consisted of weekly education sessions for patients provided by a multi-disciplinary team, after which patients had one-on-one appointments with a primary care provider if they met threshold clinical criteria. The intervention group (n=36) received the same services, plus a medication management service provided by a pharmacist during the one-on-one appointments. Results: There was no statistically significant difference between the pharmacist care and standard care groups on clinical measures including glycosylated hemoglobin, low density lipoprotein and blood pressure at the end of the eighteenmonth intervention period. Conclusion: Pacific Islanders face unique health care challenges including low socioeconomic status, language barriers and differences in cultural perceptions of health care. The value of clinical pharmacy has been well-documented in the literature but further study of the role and impact of these services is warranted for high-risk populations.

scholarly journals Cultural Awareness and Sensitivity of Students in a Physical Therapy Program – A Pilot Survey

2018 ◽  
Author(s):  
Olaide Oluwole-Sangoseni ◽  
Michelle Jenkins-Unterberg
Keyword(s):  
Health Care ◽  
Physical Therapy ◽  
Cultural Sensitivity ◽  
Health Care Professionals ◽  
Cultural Awareness ◽  
Health Care Disparities ◽  
Care Delivery ◽  
The United States ◽  
Cross Sectional Survey ◽  
Significant Difference

Background: Attempts to address health and health care disparities in the United States have led to a renewed focus on the training of healthcare professionals including physical therapists. Current health care policies emphasize culturally competent care as a means of promoting equity in care delivery by health care professionals. Experts agree that cultural insensitivity has a negative association with health professionals’ ability to provide quality care. Objective: To evaluate the cultural awareness and sensitivity of physical therapy (PT) students in a didactic curriculum aimed to increase cultural awareness. Methods: Using the Multicultural Sensitivity Scale (MSS), a cross-sectional survey was conducted to assess cultural sensitivity among three groups of students, (N = 139) from a doctor of physical therapy (DPT) program at a liberal arts university in Saint Louis, MO. Results: Response rate was 76.3%. Participants (n=100) were students in first (DPT1, n=36), third (DPT3, n=36), and sixth (DPT6, n=28) year of the program. Mean ranked MSS score was DPT1 = 45.53, DPT3 = 46.60 DPT6 = 61.91. Kruskal-Wallis analysis of the mean ranked scores showed a significant difference among three groups, H = 6.05 (2, N=100), p ≤ .05. Discussion: Students who have completed the cultural awareness curriculum, and undergone clinical experiences rated themselves higher on the cultural sensitivity/awareness. Results provide initial evidence that experiential learning opportunities may help PT students to more effectively integrate knowledge from classroom activities designed to facilitate cultural competence.

scholarly journals Bundle Payment, Health Care Utilization, and Outcomes Following Surgery for Anterior, Middle, and Posterior Cranial Fossa Skull Base Meningioma: A Market Scan Analysis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Mayur Sharma ◽  
Beatrice Ugiliweneza ◽  
Maxwell Boakye ◽  
Norberto O Andaluz ◽  
Brian J Williams
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Hospital Stay ◽  
Complication Rate ◽  
The United States ◽  
Posterior Cranial Fossa ◽  
Care Utilization ◽  
Outpatient Services ◽  
Significant Difference ◽  
Cranial Fossa

Abstract INTRODUCTION Meningioma is the most common benign intracranial brain tumor accounting for approximately one-third of all primary brain tumors. The aim of our study was to compare the bundle payment, health care utilization, and outcomes following surgery for anterior (AFM), middle (MFM), and posterior cranial fossa meningioma (PFM) across the United States. METHODS We queried the Market Scan database using ICD-9 and CPT-4, from 2000 to 2016. We included adult patients who had at least 24 mo of enrollment following the surgical procedure. The outcome of interest was length of hospital stay, disposition, complications, and reoperation following the procedure. RESULTS A cohort of 1,188 patients was identified from the database. In all 43.86% of tumors were AFM, 32.32% were MFM, and only 23.8% were PFM. Patients who underwent surgery for PFM had significant longer hospital stay (P = .0013), higher complication rate (P = .0009), and less likely to be discharged home (P = .0013) during index hospitalization. Patients with MFM and PFM incurred higher outpatient services with no differences in corresponding payments compared to those with AFM at 12 mo (P < .0001) and 24 mo follow-up (P < .0001). There were no differences in overall payments at 12 mo (AFM: $19,702; MFM: $20,671; PFM: $20,922) and 24 mos (AFM: $37,142; MFM: $44,133; PFM: $36,601) among the cohorts. There was no significant difference in 90-d median bundle payments among the groups, $66,173 (AFM) vs $65,602 (MFM), and $71,837 (PFM), P = .1955. CONCLUSION Ninety-day bundle payment and overall payments (at 12 mo and 24 mo) were not significantly different among the cohorts. Patients with PFM had longer hospital stay, higher complication rate, and less likely to be discharged home with higher utilization of outpatient services at 12 mo and 24 mo.

scholarly journals Knowledge and attitude of health care professional’s towards clinical pharmacy services in Nedjo General Hospital, Western Ethiopia

2019 ◽  
Vol 5 (7) ◽  
pp. 172 ◽  
Author(s):  
Ginenus Fekadu ◽  
Busha Gamachu ◽  
Teklie Mengie ◽  
Mudasir Maqbool
Keyword(s):  
Health Care ◽  
General Hospital ◽  
Clinical Pharmacy ◽  
Health Care Professionals ◽  
Positive Attitude ◽  
Good Knowledge ◽  
Clinical Pharmacy Service ◽  
Pharmacy Services ◽  
Clinical Pharmacy Services ◽  
Significant Difference

<p class="abstract"><strong>Background:</strong> Clinical pharmacy service (CPS) is an expanding patient-oriented, hospital role with the potential for encroachment on the physician's role. In large part, the success of CPS will depend on the degree to which other health professionals accept the concept and are willing to cooperate with its disciples. Unfortunately, our information about the degree of knowledge regarding acceptance and reaction toward clinical pharmacy by other health workers is meager.</p><p class="abstract"><strong>Methods:</strong> A cross sectional study design was carried out by using self–administered questionnaires on 110 health care professionals (HCP) in Nedjo General Hospital 10th March to 10th April, 2018.</p><p class="abstract"><strong>Results:</strong> From the total respondents 91 (82.7%) were males and majority of them were nurses 46 (41.8%) followed by midwifes 23 (20.9%). This study showed that 67 (60.9%) of the HCPs had a good knowledge and 67.3% of the HCPs had a positive attitude about CPS. There was no significant difference between the HCPs knowledge of clinical pharmacy services in relation to their sex (p=0.744), age (p=0.313), profession (p=0.997), level of education (p=0.509), and experience (p=0.553). Regarding HCPs’ attitude of CPs role, there was no significant difference in relation to their sex (p=0.588), age (p=0.144), profession (p=0.059) and experience (p=0.394). However, the study revealed that there was a significant difference (p=0.009) between HCPs attitude and level education of HCPs.</p><p><strong>Conclusions:</strong> Majority of the HCPs had a good knowledge and a positive attitude towards CPS. Attention should focus to hospitals to implement ward based CPS and increasing inter-professional relationships between HCPs and pharmacists. </p>

scholarly journals Factors Associated With Burnout Among US Hospital Clinical Pharmacy Practitioners: Results of a Nationwide Pilot Survey

2017 ◽  
Vol 52 (11) ◽  
pp. 742-751 ◽  
Author(s):  
G. Morgan Jones ◽  
Neil A. Roe ◽  
Les Louden ◽  
Crystal R. Tubbs
Keyword(s):  
Health Care ◽  
Clinical Pharmacy ◽  
Response Rate ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Hospital Setting ◽  
The United States ◽  
Pilot Survey ◽  
Clinical Pharmacists ◽  
Burnout Rate

Background: In health care, burnout has been defined as a psychological process whereby human service professionals attempting to positively impact the lives of others become overwhelmed and frustrated by unforeseen job stressors. Burnout among various physician groups who primarily practice in the hospital setting has been extensively studied; however, no evidence exists regarding burnout among hospital clinical pharmacists. Objective: The aim of this study was to characterize the level of and identify factors independently associated with burnout among clinical pharmacists practicing in an inpatient hospital setting within the United States. Methods: We conducted a prospective, cross-sectional pilot study utilizing an online, Qualtrics survey. Univariate analysis related to burnout was conducted, with multivariable logistic regression analysis used to identify factors independently associated with the burnout. Results: A total of 974 responses were analyzed (11.4% response rate). The majority were females who had practiced pharmacy for a median of 8 years. The burnout rate was high (61.2%) and largely driven by high emotional exhaustion. On multivariable analysis, we identified several subjective factors as being predictors of burnout, including inadequate administrative and teaching time, uncertainty of health care reform, too many nonclinical duties, difficult pharmacist colleagues, and feeling that contributions are underappreciated. Conclusions: The burnout rate of hospital clinical pharmacy providers was very high in this pilot survey. However, the overall response rate was low at 11.4%. The negative effects of burnout require further study and intervention to determine the influence of burnout on the lives of clinical pharmacists and on other health care–related outcomes.

scholarly journals Managed care, capitation, and the future of nephrology.

1997 ◽  
Vol 8 (10) ◽  
pp. 1618-1623
Author(s):  
T I Steinman
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Health Care Providers ◽  
Care Delivery ◽  
Chronically Ill ◽  
The United States ◽  
Management Service ◽  
Care Providers ◽  
Starting Point ◽  
The Future

Within the next decade, it is predicted that more than 90% of the United States population will receive its health insurance through managed care. Capitation will be the reimbursement mechanism to health care providers as the major way of controlling costs. Currently, managed care has had little experience with capitation payments for chronically ill patients, who consume large financial and physical resources. The end-stage renal disease (ESRD) population represents a vulnerable group of patients, and their care may be compromised in a capitated environment. Nephrologists will need to serve as advocates for ESRD patients through a mechanism of quality of care, driven by a continuous quality improvement model. Cost-effective delivery of care will occur as nephrologists join together to form Independent Practice Associations (IPAs). In this article, the role of a nephrologist in a capitated environment is outlined in detail, and background for the basis of managed care growth is provided as a framework for understanding the change in our health care delivery system. After formation of a nephrology IPA, there will most likely be a linkage with a management service organization (MSO). A business plan driven by the highest principles will allow nephrologists to work together as a cohesive force in accepting global risk capitated contracts. The starting point is for ESRD care, and the future includes pre-ESRD care.

scholarly journals A Shared Medical Appointment on the Benefits and Risks of Opioids Is Associated With Improved Patient Confidence in Managing Chronic Pain

2017 ◽  
Vol 4 (3) ◽  
pp. 144-151 ◽  
Author(s):  
Robert J Romanelli ◽  
Marina Dolginsky ◽  
Yuliya Byakina ◽  
Deborah Bronstein ◽  
Sandra Wilson
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Health Care Providers ◽  
Care Delivery ◽  
Health Care Delivery System ◽  
Care Providers ◽  
Medical Appointment ◽  
Shared Medical Appointment ◽  
Mean Differences ◽  
Patient Confidence

Objectives: To evaluate a shared medical appointment (SMA) on opioids in the treatment of chronic pain. Research design: This prospective study was conducted at an ambulatory clinic within a health-care delivery system. The SMA is a single 90-minute encounter, led by a physician. We included adult patients who attended the SMA and completed an immediate pre–post survey. Survey items were measured on a scale from 0 (worst) to 5 (best). Mean differences in pre–post responses were assessed by a paired t test. Results: A total of 130 patients were included in the analysis. Patients showed improvements in confidence in self-managing pain (+0.44; 95% confidence interval [CI]: 0.29-0.59; P < .001) and their providers’ ability to help manage pain (+0.28; 95% CI: 0.14-0.43; P < .001). Most patients (81%) were very/extremely satisfied with the SMA. Conclusions: An SMA on the benefits and risks of opioids was associated with prompt improvements in patients’ confidence in self-managing pain and in their health-care providers’ ability to help manage pain. Such confidence can lay the foundation for increased patient engagement and activation in pain management.

scholarly journals Hydroxychloroquine for pre-exposure prophylaxis of COVID-19 in health care workers: a randomized, multicenter, placebo-controlled trial (HERO-HCQ)

2021 ◽  
Author(s):  
Susanna Naggie ◽  
Aaron Milstone ◽  
Mario Castro ◽  
Sean P Collins ◽  
Lakshmi Seetha ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Workers ◽  
Controlled Trial ◽  
Composite Endpoint ◽  
The United States ◽  
Clinical Infection ◽  
Double Blind ◽  
Safety Issues ◽  
Care Workers ◽  
Significant Difference

Objective: To determine whether hydroxychloroquine (HCQ) is safe and effective at preventing COVID-19 infections among health care workers (HCW). Design: Multicenter, 1:1 randomized, placebo-controlled, double-blind, parallel-group, superiority trial. Setting: 34 clinical centers in the United States. Participants: 1360 HCW at risk for COVID-19 infection enrolled between April and November 2020. Interventions: A loading dose of HCQ 600 mg twice on Day 1 followed by 400 mg daily for 29 days or matching placebo taken orally. Main Outcome Measure: Composite of confirmed or suspected COVID-19 clinical infection by Day 30 defined as new onset fever, cough, or dyspnea and either a positive SARS-CoV-2 PCR test (confirmed) or a lack of confirmatory testing due to local restrictions (suspected). Results: Enrollment for the study was closed before full accrual due to difficulties recruiting additional participants. The primary composite endpoint occurred in 41 (6.0%) participants receiving HCQ and 53 (7.8%) participants receiving placebo. No statistically significant difference in the proportion of participants experiencing clinical infection (estimated difference of -1.8%, 95% confidence interval -4.6% to 0.9%, p=0.20). We identified no significant safety issues. Conclusion: Oral HCQ taken as prescribed appeared to be safe in a group of HCW. No significant clinical benefits were observed. The study was underpowered to rule out a small but potentially important reduction in COVID-19 infections.

scholarly journals Integrated Behavioral Health Care in Family Medicine Residencies

2018 ◽  
Vol 50 (5) ◽  
pp. 380-384 ◽  
Author(s):  
Christine Jacobs ◽  
Jay A. Brieler ◽  
Joanne Salas ◽  
Renée M. Betancourt ◽  
Peter F. Cronholm
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Family Medicine ◽  
Behavioral Health ◽  
Behavioral Health Care ◽  
Program Directors ◽  
The United States ◽  
Training Methods ◽  
Significant Difference

Background and Objectives: Behavioral health integration (BHI) in primary care settings is critical to mental health care in the United States. Family medicine resident experience in BHI in family medicine residency (FMR) continuity clinics is essential preparation for practice. We surveyed FMR program directors to characterize the status of BHI in FMR training. Methods: Using the Council of Academic Family Medicine Educational Research Alliance (CERA) 2017 survey, FMR program directors (n=478, 261 respondents, 54.6% response rate) were queried regarding the stage of BHI within the residency family medicine center (FMC), integration activities at the FMC, and the professions of the BH faculty. BHI was characterized by Substance Abuse and Mental Health Services Agency (SAMHSA) designations within FMRs, and chi-square or ANOVA with Tukey honest significant difference (HSD) post hoc testing was used to assess differences in reported BHI attributes. Results: Program directors reported a high level of BHI in their FMCs (44.1% full integration, 33.7% colocated). Higher levels of BHI were associated with increased use of warm handoffs, same day consultation, shared health records, and the use of behavioral health (BH) professionals for both mental health and medical issues. Family physicians, psychiatrists, and psychologists were most likely to be training residents in BHI. Conclusions: Almost half of FMR programs have colocated BH care or fully integrated BH as defined by SAMHSA. Highly integrated FMRs use a diversity of behavioral professionals and activities. Residencies currently at the collaboration stage could increase BH provider types and BHI practices to better prepare residents for practice. Residencies with full BHI may consider focusing on supporting BHI-trained residents transitioning into practice, or disseminating the model in the general primary care community.

Do Hospitals Need to Extend Telehealth Services? An Experimental Study of Different Telehealth Modalities during the COVID-19 Pandemic

2021 ◽  
Author(s):  
Pouyan Esmaeilzadeh ◽  
Tala Mirzaei
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care Systems ◽  
The United States ◽  
Care Practice ◽  
Care Providers ◽  
Face To Face ◽  
Virtual Care ◽  
Significant Difference ◽  
Care Systems

Abstract Background The COVID-19 pandemic has changed health care systems and clinical workflows in many countries, including the United States. This public health crisis has accelerated the transformation of health care delivery through the use of telehealth. Due to the coronavirus' severity and pathogenicity, telehealth services are considered the best platforms to meet suddenly increased patient care demands, reduce the transformation of the virus, and protect patients and health care workers. However, many hospitals, clinicians, and patients are not ready to switch to virtual care completely. Objectives We designed six experiments to examine how people (as an actual beneficiary of telehealth) evaluate five telehealth encounters versus face-to-face visits. Methods We used an online survey to collect data from 751 individuals (patients) in the United States. Results Findings demonstrate that significant factors for evaluating five types of telehealth encounters are perceived convenience expected from telehealth encounters, perceived psychological risks associated with telehealth programs, and perceived attentive care services delivered by telehealth platforms. However, significant elements for comparing telehealth services with traditional face-to-face clinic visits are perceived cost-saving, perceived time-saving, perceived hygienic services, perceived technical errors, perceived information completeness, perceived communication barriers, perceived trust in medical care platforms' competency, and perceived privacy concerns. Conclusion Although the in-person visit was reported as the most preferred care practice, there was no significant difference between people's willingness to use face-to-face visits versus virtual care. Nevertheless, before the widespread rollout of telehealth platforms, health care systems need to determine and address the challenges of implementing virtual care to improve patient engagement in telehealth services. This study also provides practical implications for health care providers to deploy telehealth effectively during the pandemic and postpandemic phases.

Business: The Electronic Health Record: Front Line Experience

2011 ◽  
Vol 21 (1) ◽  
pp. 18-22
Author(s):  
Rosemary Griffin
Keyword(s):  
Health Care ◽  
Information Technology ◽  
Electronic Health Record ◽  
Financial Incentives ◽  
Best Practice ◽  
Health Care Systems ◽  
The United States ◽  
Health Record ◽  
Health Trends ◽  
Electronic Health

National legislation is in place to facilitate reform of the United States health care industry. The Health Care Information Technology and Clinical Health Act (HITECH) offers financial incentives to hospitals, physicians, and individual providers to establish an electronic health record that ultimately will link with the health information technology of other health care systems and providers. The information collected will facilitate patient safety, promote best practice, and track health trends such as smoking and childhood obesity.

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