Bridging the Gap for Children With Compound Health Challenges: An Intervention Protocol

Background: During the last decades, there is a major shift in the panorama of diseases in children and adolescents. More children are referred to the specialized health care services due to less specific symptoms and more complex health challenges. These children are particularly difficult to care for in a “single-disease” oriented system. Our objective was to develop an alternative and more holistic approach better tailored to the complex needs of these children.Method: The target patient population is children between 6 and 13 years with three or more referrals including both the pediatric department and the mental health services. Furthermore, to be included in the project, the child's actual complaints needed to be clinically considered as an unclear or compound condition in need of an alternative approach. This paper describes the process of developing an intervention where a complementary professional team meets the patient and his/her family altogether for 2.5 h. The consultation focus on clarifying the complex symptomatology and on problem solving. The bio-psycho-social model is applied, emphasizing the patient's story as told on the whiteboard. In the dynamic processes of development, piloting, evaluating, and adjusting the components, feed-back from the patients, their families, professional team members, and external team coaches is important.The professional teams include pediatricians, psychologists and physiotherapists. Achieving the transformation from a logistic oriented team where members act separately toward a real complementary team, seems to be a success factor.Discussion: Composing multi-disciplinary and complementary teams was an essential part of the re-designed intervention. Team interaction transforming the professionals from working as a logistic team to act as a complementary team, was one of the important requirements in the process. When re-designing the specialist health service, it is mandatory to anchor all changes among employees as well as the hospital leadership. In addition, it is important to include patient experiences in the process of improvement. Evaluation of long-term outcomes is needed to investigate possible benefits from the new intervention.Trial Registration: Transitioning Young Patients' Health Care Trajectories, NCT04652154. Registered December 3rd, 2020–Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04652154?term=NCT04652154&draw=2&rank=1.

Download Full-text

The Management of Idiopathic Chronic Pain: A Holistic Approach

The Canadian Journal of Psychiatry ◽

10.1177/070674378102600609 ◽

1981 ◽

Vol 26 (6) ◽

pp. 429-431

Author(s):

H. Brent Richard ◽

Gerald H. Flamm

Keyword(s):

Health Care ◽

Chronic Pain ◽

Psychosomatic Medicine ◽

Health Care Services ◽

Holistic Approach ◽

Secondary Gain ◽

Biopsychosocial Approach ◽

Care Services ◽

Recent Developments ◽

Symptom Formation

The evaluation and treatment of the patient with idiopathic chronic pain traditionally has involved a sequence of studies first by the internist, then the neurologist, and finally the psychiatrist. This has resulted in an overutilization of costly health care services and may paradoxically have helped to promote symptom chronicity. In keeping with recent developments in the field of psychosomatic medicine, a coordinated biopsychosocial approach is advocated with the identification and amelioration of the multiple determinants of symptom formation in each of these interrelated sub-systems. A case is presented in which the application of this holistic approach appeared to help curtail the overuse of health care services and at the same time helped to diminish psychosocial reinforcers in the form of secondary gain.

Download Full-text

Protections for Marginalised Women in University Sexual Violence Policies

International Journal for Crime Justice and Social Democracy ◽

10.5204/ijcjsd.v9i1.1451 ◽

2020 ◽

Vol 9 (1) ◽

pp. 13-30

Author(s):

Amelia Roskin-Frazee

Keyword(s):

Higher Education ◽

Health Care ◽

Sexual Violence ◽

Gender Equality ◽

Health Care Services ◽

Higher Education Institutions ◽

The United States ◽

Complex Needs ◽

Care Services ◽

The United Kingdom

Higher education institutions in four of the top 20 wealthiest nations globally (measured by GDP per capita) undermine gender equality by failing to address sexual violence perpetrated against women with marginalised identities. By analysing student sexual violence policies from 80 higher education institutions in Australia, Canada, the United Kingdom, and the United States, I argue that these policies fail to account for the ways that race, sexuality, class and disability shape women’s experiences of sexual violence. Further, these deficiencies counteract efforts to achieve gender equality by tacitly denying women who experience violence access to education and health care. The conclusion proposes policy alterations designed to address the complex needs of women with marginalised identities who experience violence, including implementing cultural competency training and increasing institution-sponsored health care services for sexual violence survivors.

Download Full-text

Accessibility of children with special health needs to the health care network

Revista Brasileira de Enfermagem ◽

10.1590/0034-7167-2017-0899 ◽

2019 ◽

Vol 72 (suppl 3) ◽

pp. 65-71

Author(s):

Eliane Tatsch Neves ◽

Aline Cristiane Cavicchioli Okido ◽

Fernanda Luisa Buboltz ◽

Raíssa Passos dos Santos ◽

Regina Aparecida Garcia de Lima

Keyword(s):

Health Care ◽

Primary Health Care ◽

Health Care Services ◽

Health Needs ◽

Structured Interviews ◽

Care Network ◽

Her Family ◽

Primary Health ◽

Health Care Network ◽

Special Health

ABSTRACT Objective: To know how children with special health needs access the health care network. Method: This is a qualitative research of descriptive-exploratory type, developed using semi-structured interviews mediated by the Talking Map design. Participants were 19 family caregivers of these children in two Brazilian municipalities. Data were submitted to inductive thematic analysis. Results: Difficulties were mentioned from the diagnosis moment to the specialized follow-up, something represented by the itinerary of the c hild and his/her family in the search for the definition of the medical diagnosis and the access to a specialized professional; a gap between the children’s needs and the care offered was observed in primary health care. Conclusion: The access of children with special health needs is filled with obstacles such as slowness in the process of defining the child’s diagnosis and referral to a specialist. Primary health care services were replaced by care in emergency care units.

Download Full-text

A COVID-19 field hospital in a conference centre – The Cape Town, South Africa experience

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v13i1.3140 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Bonny Bulajic ◽

Kamlin Ekambaram ◽

Colleen Saunders ◽

Vanessa Naidoo ◽

Lee Wallis ◽

...

Keyword(s):

Health Care ◽

Health Care Services ◽

Care Service ◽

Health Planning ◽

Health Care Service ◽

Cape Town ◽

Strategy Development ◽

Success Factor ◽

Future Health ◽

Field Hospital

Background: The coronavirus pandemic has put extreme pressure on health care services in South Africa.Aim: To describe the design, patients and outcomes of a field hospital during the first wave of the coronavirus disease 2019 (COVID-19) pandemic.Setting: The Cape Town International Convention Centre was the first location in Cape Town to be commissioned as a field hospital that would serve as an intermediate care bed facility.Methods: This was a retrospective descriptive study of patients admitted to this facility between 8th June 2020 and 14th August 2020 using deidentified data extracted from patient records.Results: There were 1502 patients admitted, 56.4% female, with a mean age of 58.6 years (standard deviation [s.d.]: 14.2). The majority of patients (82.9%) had at least one comorbidity, whilst 15.4% had three or more. Nearly 80.0% (79.8%) of patients required oxygen and 63.5% received steroids, and only 5.7% of patients were required to be transferred for escalation of care. The mean length of stay was 6 days (s.d.: 4.8) with an overall mortality of 5.7%.Conclusion: This study highlights the role of a field hospital in providing surge capacity. Its use halved the predicted duration of stay at acute care hospitals, allowing them the capacity to manage more unstable and critical patients. Adaptability and responsivity as well as adequate referral platforms proved to be crucial. Daily communication with the whole health care service platform was a critical success factor. This study provides information to assist future health planning and strategy development in the current pandemic and future disease outbreaks.

Download Full-text

TEAM WORK IN A MEDICAL UNIT: DREAM OR A REALITY

10.36106/ijsr/2801560 ◽

2020 ◽

pp. 1-2

Author(s):

Manika Agarwal ◽

Sharat Agarwal

Keyword(s):

Health Care ◽

Health Care Services ◽

Collective Intelligence ◽

Health Care Systems ◽

Division Of Labour ◽

Shared Responsibility ◽

Team Work ◽

Team Members ◽

Care Systems

‘TEAM- Together Everyone Achieves More’ is a guiding principle in all departments in all organizations. On literature search, we can find plenty of materials relating to goals, principles and strategies for team work in health care settings. But are we practising it in clinical settings? And if not, is it due to lack of knowledge and skill regarding implementation of strategies for team work or is it due to attitude problems of leaders who want to force their way of thinking and their opinion in everything and then blame others or juniors for any error which is incurred? Cohesive health care teams have 5 key characteristics- Clear goals with measurable outcomes, clinical administrative systems, division of labour, training of all team members and effective communication [1]. The quality of team work is associated with higher quality of patient safety care systems and is imperative in reducing errors. This requires that staff be comfortable in recognizing and discussing challenging situations. Structural briefing and debriefing are an effective team strategy, but they like all other interventions require strong leadership to realize their benefits [2]. The hall mark of high performing organizations is that leaders defined a very clear set of behaviours that apply to everyone whether they clean the floor or are the chief of staff [3]. Smart teams are not simple team of smart members and collective intelligence requires social perceptiveness of team members or their ability to infer others mental state such as beliefs or feeling based subtle cues [4]. The study highlights that for creating smart team two critical communication processes are required from team members i.e. (a). Speak up when their expertise can be useful & (b). Influence the team’s work so that the team does its collective best for the patient [4]. The incorporation of sharing responsibilities with accountability between team members in health care systems offers great benefit. However, shared responsibility without high quality team work can result in immediate risk for patients [5]. As is a common saying ‘where everyone is responsible actually no one is responsible’, which can be a dangerous situation for health care services.

Download Full-text

The Role of the Pediatrician in Substance Abuse Counseling

PEDIATRICS ◽

10.1542/peds.72.2.251 ◽

1983 ◽

Vol 72 (2) ◽

pp. 251-252

Author(s):

Keyword(s):

Health Care ◽

Substance Abuse ◽

Rapid Change ◽

Young Patients ◽

The Body ◽

Substance Abuse Counseling ◽

Her Family ◽

Community Agencies ◽

The Past ◽

Large Numbers

The past two decades have been marked by both an increasing recognition of the pediatrician's responsibilities toward the adolescent and the emergence of substance abuse as a critical concern for those who care for children and youth. The use and abuse of psychoactive substances have become common even among young adolescents, and the pediatrician must be prepared to address this issue as part of routine health care. In addition, the counsel of the pediatrician regarding substance abuse is often sought by families, schools, and community agencies. Familiarity with the extent and nature of adolescent drug use, as well as the health consequences of such use, has become a necessary part of the body of pediatric knowledge. The pediatrician must possess the skills necessary to determine which young patients are at risk from substance abuse and be able to offer appropriate counseling to the adolescent and his or her family so as to minimize the risk of future illness and dysfunction. The pattern of substance abuse among teenagers has undergone rapid change during the past 15 years. During the late 1960s the abuse of psychoactive drugs, previously a predominantly adult phenomenon, became widespread among adolescents. Opiates, amphetamines, barbiturates, hallucinogens, and inhalants were all used and abused by large numbers of teenagers.1 The use of tobacco in this age group represents a significant health threat, and during the past decade the use of cocaine and other intoxicants, in particular alcohol and marijuana, has increased dramatically among adolescents. These drugs now cause major concern to those who provide health care for teenagers.

Download Full-text

Effect of interventions to improve health care services for ethnic minority populations

Norsk Epidemiologi ◽

10.5324/nje.v20i1.1294 ◽

2011 ◽

Vol 20 (1) ◽

Author(s):

Louise Forsetlund ◽

Morten Christoph Eike ◽

Gunn E. Vist

Keyword(s):

Health Care ◽

Cancer Screening ◽

Ethnic Minority ◽

Health Care Services ◽

Young Patients ◽

Educational Interventions ◽

Improve Health Care ◽

Care Services ◽

Improve Health

Objectives: Since the early 1990s there has been an increasing awareness of social and ethnic inequity in health and for the last few years there has also been an increasing focus on disparities in the quality of health services to ethnic minority groups. The aim of this review was to collect and summarise in a systematic and transparent manner the effect of interventions to improve health care services for ethnic minorities.<br />Methods: We searched several medical databases for systematic reviews and randomised controlled trials. Two researchers independently screened for and selected studies, assessed risk of bias, extracted data and graded the quality of the evidence for each outcome in the included studies. The analysis was done qualitatively by describing studies and presenting them in tables.<br />Results: We included 19 primary studies. The interventions were targeted at reducing clinical, structural and organisational barriers against good quality health care services. Eight studies examined the effect of educational interventions in improving outcomes within cross-cultural communication, smoking cessation, asthma care, cancer screening and mental health care. In six comparisons the effect of reminders for improving health care services and patient outcomes within cancer screening and diabetes care was examined. Two studies compared professional remote interpretation services to traditional interpretation services, two studies compared ethnic matching of client and therapist and two studies examined the effect of providing additional support in the form of more personnel in the treatment of diabetes and kidney transplant patients. Most patients were African-Americans and Latin-Americans and all ages were represented.<br />Conclusions: Educational interventions and electronic reminders to physicians may in some contexts improve health care and health outcomes for minority patients. The quality of the evidence varied from low to very low. The quality of available evidence for the other interventions was too low to draw reliable conclusions. We found no studies that only included young patients, but we suggest that interventions targeted at health personnel or health organisations may be applicable regardless of the age of the patient population. This review reveals that the evidence for interventions to improve health care for minorities is sparse and generally of low quality.

Download Full-text

Public health job vacancies — who wants what, where?

Australian Health Review ◽

10.1071/ah050226 ◽

2005 ◽

Vol 29 (2) ◽

pp. 226 ◽

Cited By ~ 7

Author(s):

Arie Rotem ◽

John C Dewdney ◽

Nadine A Mallock ◽

Tanya R Jochelson

Keyword(s):

Health Care ◽

Health Care Services ◽

Well Being ◽

Role Clarity ◽

Team Members ◽

Effective Teams ◽

Quality Patient Care ◽

Care Services ◽

Antecedent Conditions ◽

Team Evaluation

While it is recognised that effective health care teams are associated with quality patient care, the literature is comparatively sparse in defining the outcomes of effective teamwork. This literature review of the range of organisational, team and individual benefits of teamwork complements an earlier article which summarised the antecedent conditions for (input) and team processes (throughput) of effective teams. This article summarises the evidence for a range of outcome measures of effective teams. Organisational benefits of teamwork include reduced hospitalisation time and costs, reduced unanticipated admissions, better accessibility for patients, and improved coordination of care. Team benefits include efficient use of health care services, enhanced communication and professional diversity. Patients report benefits of enhanced satisfaction, acceptance of treatment and improved health outcomes. Finally, team members report enhanced job satisfaction, greater role clarity and enhanced well-being. Due to the inherent complexity of teamwork, a constituency model of team evaluation is supported where key stakeholders identify and measure the intended benefits of a team.

Download Full-text