scholarly journals Optimal primary care management of clinical osteoarthritis and joint pain in older people: a mixed-methods programme of systematic reviews, observational and qualitative studies, and randomised controlled trials

2018 ◽  
Vol 6 (4) ◽  
pp. 1-260 ◽  
Author(s):  
Elaine Hay ◽  
Krysia Dziedzic ◽  
Nadine Foster ◽  
George Peat ◽  
Danielle van der Windt ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Professionals ◽  
Best Practice ◽  
Research Programme ◽  
Anxiety And Depression ◽  
Knee Oa ◽  
Randomised Controlled

BackgroundOsteoarthritis (OA) is the most common long-term condition managed in UK general practice. However, care is suboptimal despite evidence that primary care and community-based interventions can reduce OA pain and disability.ObjectivesThe overall aim was to improve primary care management of OA and the health of patients with OA. Four parallel linked workstreams aimed to (1) develop a health economic decision model for estimating the potential for cost-effective delivery of primary care OA interventions to improve population health, (2) develop and evaluate new health-care models for delivery of core treatments and support for self-management among primary care consulters with OA, and to investigate prioritisation and implementation of OA care among the public, patients, doctors, health-care professionals and NHS trusts, (3) determine the effectiveness of strategies to optimise specific components of core OA treatment using the example of exercise and (4) investigate the effect of interventions to tackle barriers to core OA treatment, using the example of comorbid anxiety and depression in persons with OA.Data sourcesThe North Staffordshire Osteoarthritis Project database, held by Keele University, was the source of data for secondary analyses in workstream 1.MethodsWorkstream 1 used meta-analysis and synthesis of published evidence about effectiveness of primary care treatments, combined with secondary analysis of existing longitudinal population-based cohort data, to identify predictors of poor long-term outcome (prognostic factors) and design a health economic decision model to estimate cost-effectiveness of different hypothetical strategies for implementing optimal primary care for patients with OA. Workstream 2 used mixed methods to (1) develop and test a ‘model OA consultation’ for primary care health-care professionals (qualitative interviews, consensus, training and evaluation) and (2) evaluate the combined effect of a computerised ‘pop-up’ guideline for general practitioners (GPs) in the consultation and implementing the model OA consultation on practice and patient outcomes (parallel group intervention study). Workstream 3 developed and investigated in a randomised controlled trial (RCT) how to optimise the effect of exercise in persons with knee OA by tailoring it to the individual and improving adherence. Workstream 4 developed and investigated in a cluster RCT the extent to which screening patients for comorbid anxiety and depression can improve OA outcomes. Public and patient involvement included proposal development, project steering and analysis. An OA forum involved public, patient, health professional, social care and researcher representatives to debate the results and formulate proposals for wider implementation and dissemination.ResultsThis programme provides evidence (1) that economic modelling can be used in OA to extrapolate findings of cost-effectiveness beyond the short-term outcomes of clinical trials, (2) about ways of implementing support for self-management and models of optimal primary care informed by National Institute for Health and Care Excellence recommendations, including the beneficial effects of training in a model OA consultation on GP behaviour and of pop-up screens in GP consultations on the quality of prescribing, (3) against adding enhanced interventions to current effective physiotherapy-led exercise for knee OA and (4) against screening for anxiety and depression in patients with musculoskeletal pain as an addition to current best practice for OA.ConclusionsImplementation of evidence-based care for patients with OA is feasible in general practice and has an immediate impact on improving the quality of care delivered to patients. However, improved levels of quality of care, changes to current best practice physiotherapy and successful introduction of psychological screening, as achieved by this programme, did not substantially reduce patients’ pain and disability. This poses important challenges for clinical practice and OA research.LimitationsThe key limitation in this work is the lack of improvement in patient-reported pain and disability despite clear evidence of enhanced delivery of evidence-based care.Future work recommendations(1) New thinking and research is needed into the achievable and desirable long-term goals of care for people with OA, (2) continuing investigation into the resources needed to properly implement clinical guidelines for management of OA as a long-term condition, such as regular monitoring to maintain exercise and physical activity and (3) new research to identify subgroups of patients with OA as a basis for stratified primary care including (i) those with good prognosis who can self-manage with minimal investigation or specialist treatment, (ii) those who will respond to, and benefit from, specific interventions in primary care, such as physiotherapy-led exercise, and (iii) develop research into effective identification and treatment of clinically important anxiety and depression in patients with OA and into the effects of pain management on psychological outcomes in patients with OA.Trial registrationCurrent Controlled Trials ISRCTN06984617, ISRCTN93634563 and ISRCTN40721988.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research Programme and will be published in full inProgramme Grants for Applied Research Programme; Vol. 6, No. 4. See the NIHR Journals Library website for further project information.

scholarly journals The management of infant developmental needs by community nurses - Part 2: The development of guidelines for the support of community nurses in the management of infant developmental needs

Curationis ◽  
2007 ◽  
Vol 30 (2) ◽  
Author(s):  
R. Leech ◽  
N.C. Van Wyk ◽  
C.J.E. Uys
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Best Practice ◽  
Scientific Information ◽  
Scope Of Practice ◽  
Developmental Needs ◽  
Developmental Care ◽  
Health Care Clinics ◽  
Research Findings

In the previous article, the author described, according to the scope of practice of registered nurses, the responsibilities oi community nurses with regard to the management of infant developmental needs in primary health care clinics in South Africa. In this article, the focus is on the development of guidelines for the support of community nurses in fulfilling these responsibilities. Before the development of the guidelines is addressed, a brief overview of the background of the study, assumptions of the researcher and the methodology of the study is given. The development of the set of guidelines (DEFINE HOPE) is set against the background of the drive to improve the quality of developmental care for infants and their families. As guidelines help to translate scientific information into statements, it could be valuable to community nurses to improve their delivery of developmental care. To gather evidence for the formulation of the guidelines, the researcher utilised the themes identified during the analysis process in phase one of the research; investigated research articles; and compared findings and recommendations of the articles with the research findings obtained in phase one. In addition to the research findings and literature review, a focus group (health care professionals represented in the case study), was utilised to assist with the final development and validation of the guidelines. The researcher adapted a number of desirable attributes for guidelines, which are indicated in the literature, to compile the criteria for validation of the guidelines. In conclusion, guidelines are necessary to support community nurses in finding “best practice” within their scope of practice to ensure higher quality of developmental care to families with infants 0-2 years.

scholarly journals Making the Transition to Insulin Therapy: The Experiences of Samoan People with Type 2 Diabetes in New Zealand

2021 ◽  
Author(s):  
◽  
Sera Tapu-Ta'ala
Keyword(s):  
Type 2 Diabetes ◽  
Health Care ◽  
New Zealand ◽  
Insulin Therapy ◽  
Health Care Professionals ◽  
Pacific People ◽  
Qualitative Descriptive

<p>Background Pacific people are dying younger compared to other New Zealanders because of complications resulting from uncontrolled type 2 diabetes mellitus. Good diabetes control is achievable with early use of insulin because of its effectiveness, and proven long term benefits to quality of life. An understanding of how Samoan people with type 2 diabetes make their transition to insulin therapy will assist in understanding how insulin is perceived, which will inform health care professionals in their work with those diagnosed with diabetes. Aim of Research The aim of the research is to explore and describe how Samoan people with type 2 diabetes in New Zealand made the transition to insulin therapy for better glycaemic control. Design The Fonofale Model was used as the theoretical framework, from which to understand Samoan peoples' experiences. This research used a qualitative descriptive methodology. In-depth interviews were used to gather the stories of four Samoan participants over the age of 18 years diagnosed with type 2 diabetes. The data was analysed using thematic analysis. Findings Three major themes emerged from the analysis of the participants' stories. These were: living with diabetes, making the transition to insulin therapy and realisation. The findings led to the creation of the Ia Malu model, which describes the experiences of the participants in this study. Conclusion This study confirmed that there are immense challenges and struggles encountered by people with diabetes. Their adjustment to the illness as well as making the transition to using insulin takes time. As a result of this, it is fundamental for nurses/health care professionals to understand that this is the reality for these people, and they must therefore provide time for people to adjust.</p>

Partnering with Parents: Establishing Effective Long-Term Relationships with Parents in the NICU

2006 ◽  
Vol 25 (5) ◽  
pp. 329-337 ◽  
Author(s):  
Mary McAllister ◽  
Kim Dionne
Keyword(s):  
Health Care ◽  
Intensive Care ◽  
Health Professionals ◽  
Health Care Professionals ◽  
Parental Role ◽  
Parent Perspectives ◽  
Duration Of Hospitalization ◽  
Newborn Intensive Care

Advances in health care have led to unprecedented innovation in the care provided to critically ill newborns. One outcome of this new reality is that newborn intensive care units have become “homes” for fragile infants who require long-term hospitalization. Clearly, NICUs were never so envisioned; thus, this reality has resulted in challenges for families and health professionals alike. As the duration of hospitalization increases, relationships between families and health care professionals become increasingly important. Parents of hospitalized newborns face fear, anxiety, and frustration as they struggle to cope with an ill child while developing their parental role. The quality of relationships established between families and health care professionals is crucial to their coping and adaptation. This article addresses challenges faced by families whose infants experience extended hospitalization, applies a model to help health care professionals understand parent perspectives, and proposes strategies to promote effective partnerships and alliances with families.

Validation of the long-term quality of life breast cancer scale (LTQOL-BC) by health care professionals

2014 ◽  
Vol 23 (6) ◽  
pp. 1629-1635 ◽  
Author(s):  
Christine Ecclestone ◽  
Sunil Verma ◽  
Angela Leahey ◽  
Gillian Bedard ◽  
Julia Hamer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Health Care ◽  
Health Care Professionals

scholarly journals Making the Transition to Insulin Therapy: The Experiences of Samoan People with Type 2 Diabetes in New Zealand

2021 ◽  
Author(s):  
◽  
Sera Tapu-Ta'ala
Keyword(s):  
Type 2 Diabetes ◽  
Health Care ◽  
New Zealand ◽  
Insulin Therapy ◽  
Health Care Professionals ◽  
Pacific People ◽  
Qualitative Descriptive

<p>Background Pacific people are dying younger compared to other New Zealanders because of complications resulting from uncontrolled type 2 diabetes mellitus. Good diabetes control is achievable with early use of insulin because of its effectiveness, and proven long term benefits to quality of life. An understanding of how Samoan people with type 2 diabetes make their transition to insulin therapy will assist in understanding how insulin is perceived, which will inform health care professionals in their work with those diagnosed with diabetes. Aim of Research The aim of the research is to explore and describe how Samoan people with type 2 diabetes in New Zealand made the transition to insulin therapy for better glycaemic control. Design The Fonofale Model was used as the theoretical framework, from which to understand Samoan peoples' experiences. This research used a qualitative descriptive methodology. In-depth interviews were used to gather the stories of four Samoan participants over the age of 18 years diagnosed with type 2 diabetes. The data was analysed using thematic analysis. Findings Three major themes emerged from the analysis of the participants' stories. These were: living with diabetes, making the transition to insulin therapy and realisation. The findings led to the creation of the Ia Malu model, which describes the experiences of the participants in this study. Conclusion This study confirmed that there are immense challenges and struggles encountered by people with diabetes. Their adjustment to the illness as well as making the transition to using insulin takes time. As a result of this, it is fundamental for nurses/health care professionals to understand that this is the reality for these people, and they must therefore provide time for people to adjust.</p>

scholarly journals Integrating mHealth alcohol harm reduction into primary care: Protocol for an implementation trial (Preprint)

2021 ◽  
Author(s):  
Andrew R Quanbeck
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Health Care ◽  
Health Care Professionals ◽  
Cost Effective ◽  
Human Interaction ◽  
Drinking Patterns ◽  
Mhealth Intervention ◽  
Implementation Costs

BACKGROUND Primary healthcare systems are uniquely positioned to provide access to strategies for reducing alcohol misuse and high-risk drinking, strategies which include mHealth apps. The extent of human interaction needed to achieve effective and cost-effective use of mHealth apps in primary care remains largely unexamined. This study seeks to understand how varying levels of human interaction affect the ways in which an mHealth intervention for the prevention and treatment of alcohol use disorders works or does not work, for whom, and under what circumstances. OBJECTIVE The primary aim is to detect the effectiveness of an mHealth intervention by assessing differences in self-reported risky drinking patterns and quality of life between participants in three study groups (self-monitored, peer-supported, and clinically integrated). Each group reflects differences in the level of human touch provided to support use of the intervention. The cost-effectiveness of each approach will be assessed . METHODS This Hybrid 1 study is an unblinded patient-level randomized clinical trial testing the effects of using an evidence-based mHealth system on participants’ drinking patterns and quality of life. There are two groups of participants for this study: individuals receiving the intervention and health care professionals practicing in the broader primary care environment. The intervention is a smartphone app encouraging users to reduce their alcohol consumption within the context of integrative medicine using techniques to build healthy habits. Primary outcomes for quantitative analysis will be participant data on their risky drinking days and quality of life, as well as app usage from weekly and quarterly surveys. Cost measures include intervention and implementation costs. Cost per participant will be determined for each study arm with intervention and implementation costs separated within each group. There will also be a qualitative assessment of health care professionals’ engagement with the app as well as their thoughts on participant experience with the app. RESULTS This protocol was approved on November 18, 2019 by the Health Sciences Minimal Risk Institutional Review Board with subsequent annual reviews. Recruitment began on March 06, 2020 but was suspended on March 13, 2020 due to COVID-19 restrictions. Limited recruitment resumed on July 6, 2020. Trial status as of June 9, 2021: 257 participants are enrolled in the study toward a planned enrollment of 546 participants. CONCLUSIONS New knowledge gained from this study could have wide and lasting benefits related to the integration of mHealth systems for alcohol use disorders in primary healthcare systems. Results of the study will guide policy makers and providers to cost-effective ways to incorporate technology in health care. CLINICALTRIAL ClinicalTrials.gov Identifier: NCT04011644

scholarly journals Long-term condition management: health professionals’ perspectives

2011 ◽  
Vol 3 (1) ◽  
pp. 16 ◽  
Author(s):  
Natasha Ashworth ◽  
Shona Thompson
Keyword(s):  
Primary Care ◽  
Health Care ◽  
New Zealand ◽  
Health Professionals ◽  
Health Care Professionals ◽  
Service Development ◽  
Health Board ◽  
Long Term Conditions ◽  
Family Nursing

INTRODUCTION: Long-term conditions (LTCs) are the leading cause of morbidity and mortality in New Zealand. The burden upon patients and health care services to manage these conditions has prompted calls for primary care to lead the way in early diagnosis and coordination of LTC care. The purpose of this study was to investigate the perspectives of health professionals in a geographically-isolated region of New Zealand regarding current levels of LTC management to provide direction for future service development. METHODS: Semi-structured, face-to-face interviews conducted in 2009 with 10 purposively sampled health professionals in the primary care field, including four general practitioners, four nurses and two management team personnel, all practising in a regional District Health Board. The resultant data were analysed using a general inductive thematic approach. FINDINGS: Three main themes were identified by the health professionals as being key issues pertaining to the management of LTCs. These are discussed as issues pertaining to management, information and communication and leadership. CONCLUSION: The results showed that LTC management is rated as highly important by health care professionals who are aware of the need to change current delivery methods to improve client outcomes. All those interviewed highlighted issues related to funding as being a significant barrier to implementing innovations in LTC management, including nurse-led services. Plans to develop integrated family health centres, information technology systems and increased collaboration between clinicians were hailed as potential solutions to improving LTC management. KEYWORDS: Chronic disease; family nursing; family practice; nurse led clinics; nurse’s practice patterns

scholarly journals Perception of the Quality of Physiotherapy Care Provided to Outpatients from Primary Health Care in Chile

2018 ◽  
Vol 43 (1) ◽  
pp. 16-22 ◽  
Author(s):  
Priscila Reyes ◽  
Fabia Puelle ◽  
René Mauricio Barría
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Health Care Professionals ◽  
Phenomenological Study ◽  
Technical Equipment ◽  
Primary Health ◽  
Semistructured Interviews ◽  
Structural Aspects

We explored outpatient’s perceptions on the quality of physiotherapy care provided in three urban primary care centers of Valdivia, Chile, through a descriptive phenomenological study. We collected data from 21 participants through semistructured interviews which were analyzed using the Colaizzi approach. Two main themes emerged: quality related to the professional and structure of the care system. Perceptions about the care received from the physiotherapist are influenced by factors such as communication, the way they treat the patient, and the trust established between patient and professional. In addition, structural aspects such as allocation of spaces, technical equipment and rehabilitation devices, access to centers, and the availability of the physiotherapist affect satisfaction and the perception of the quality of the service received. As it occurs in other health services provided by different health-care professionals, the quality of physiotherapy care is related to subjective (relational) and objective (structural) perceptions.

scholarly journals OP0321-HPR HIGHER QUALITY OF CARE AND LESS SURGERY AFTER IMPLEMENTING OSTEOARTHRITIS GUIDELINES IN PRIMARY CARE– LONG-TERM RESULTS FROM A CLUSTER RANDOMIZED CONTROLLED TRIAL

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 198.2-198
Author(s):  
N. Osteras ◽  
T. Moseng ◽  
L. Van Bodegom-Vos ◽  
K. Dziedzic ◽  
Ø. Andreassen ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Quality Of Care ◽  
Intervention Group ◽  
Satisfaction With Care ◽  
Control Group ◽  
Structured Model ◽  
Knee Oa

Background:To improve quality of care for patients with hip and knee osteoarthritis (OA), a structured model for integrated OA care was developed and implemented among general practitioners (GPs) and physiotherapists (PTs) in primary care. The model was developed based on international treatment recommendations. After 6 months, patient-reported quality of care and satisfaction with care were greater, more patients were referred to physiotherapy and fewer to orthopaedic surgeon, and more patients fulfilled physical activity criteria among OA patients receiving the new model of care compared to the usual care control group1.Objectives:To assess the long-term effects 12 months after implementing the model in primary care.Methods:A cluster-randomised controlled trial with a stepped-wedge design was conducted in six Norwegian municipalities (clusters). The intervention included implementation of the model, facilitated by interactive workshops for GPs and PTs. The main components of the model were a PT led, 3 hour patient education programme followed by 8-12 weeks of individually tailored, supervised exercise. Patient participants were ≥45 years with symptomatic hip or knee OA. Primary outcome was patient-reported quality of care (OsteoArthritis Quality Indicator questionnaire; 0–100, 100 = optimal quality). Secondary outcomes included satisfaction with care, referrals to physiotherapy, orthopaedic surgeon and magnetic resonance imaging (MRI), joint replacement surgery, fulfilment of physical activity recommendations, and proportion with overweight (body mass index ≥25 kg/m2). Data was analysed using multilevel mixed models adjusted for age, sex and secular time.Results:In all, 40 of 80 GPs and 37 of 64 PTs attended the workshops. A total of 393 patients with hip and knee OA were included, with 284 in the intervention and 109 in the usual care control group. In the intervention group, 92% attended the OA education programme and 64% completed ≥8 weeks of exercise. At 12 months the intervention group reported significantly higher quality of care (score 58 vs. 41, mean difference: 17.6; 95% CI 11.1, 24.0) compared to the control group. The intervention group reported significantly higher satisfaction with care (Odds ratio (OR) 7.8; 95% CI 3.55, 17.27) and a significantly larger proportion (OR: 4.0; 95% CI 1.27, 12.63) met the recommendations for physical activity compared to the control group. A smaller proportion was referred to orthopaedic surgeon (OR 0.5; 95% CI 0.29, 1.00) and a smaller proportion received joint replacement surgery in the intervention (4%) compared to the control group (11%) (OR 0.3; 95% CI 0.14, 0.74). The proportion of patients referred to physiotherapy or MRI and the proportion with overweight were similar between the groups.Conclusion:Implementation of a structured model for OA care led to improved quality of care, higher satisfaction with care and higher physical activity levels after 12 months. These results are comparable to the 6 months results, which indicate a long-term persistence in the beneficial effects of the intervention. The lower surgical rate in the intervention compared to the control group suggests that higher uptake of OA recommendations in primary care may reduce or postpone the need for surgery in people with hip or knee OA.References:[1]Østerås N, Moseng T, Bodegom-Vos LV, et al. Implementing a structured model for osteoarthritis care in primary healthcare: A stepped-wedge cluster-randomised trial.PLOS Medicine.2019;16(10):e1002949.Disclosure of Interests:None declared

Continuity of care for children in the ‘too hard’ basket: a literature review of care needs in the health system

1996 ◽  
Vol 21 (2) ◽  
pp. 17-22
Author(s):  
Cas O'Neill ◽  
Julie Contole ◽  
Robyne Schwarz ◽  
Doug Bryan ◽  
Christine Minogue
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Collaborative Research ◽  
Health Care Needs ◽  
Review Of Literature ◽  
Care Needs ◽  
Research Findings ◽  
Set Up

The following review of literature arose from Project Partnership, an initiative of the Royal Children's Hospital, Melbourne, which was set up to identify systemic and organisational changes which could improve continuity and quality of care for children with long-term and complex health care needs. This article examines research findings and other literature relevant to the experience of families whose children have complex health care needs; the experience of hospital based, health care professionals who care for this group of children; and the complexities of undertaking collaborative research in a large health bureaucracy.

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