scholarly journals Remote primary care consultations for people living with dementia during the COVID-19 pandemic: experiences of people living with dementia and their carers

2021 ◽  
pp. BJGP.2020.1094 ◽  
Author(s):  
Remco Tuijt ◽  
Greta Rait ◽  
Rachael Frost ◽  
Jane Wilcock ◽  
Jill Manthorpe ◽  
...  
Keyword(s):  
Primary Care ◽  
Best Practice ◽  
Qualitative Interviews ◽  
Healthcare Services ◽  
Structured Interviews ◽  
Healthcare Provision ◽  
Healthcare Settings ◽  
Healthcare Needs ◽  
Remote Healthcare ◽  
Remote Consultations

Background: COVID-19 has accelerated remote healthcare provision in primary care, with changes potentially permanent. The implementation of remote provision of healthcare needs to hear from vulnerable populations, such as people living with dementia. Aim: To understand the remote healthcare experiences of patients living with dementia and their family carers during the COVID-19 pandemic. Design and setting: Qualitative interviews with community-based patients living with dementia and their carers during early months (May-August 2020) of the COVID-19 pandemic in England. Methods: Semi-structured interviews were conducted remotely by telephone or video call with 30 patients living with dementia and 31 carers. Data were analysed using thematic analysis. Results: Three main themes were derived relating to: 1) proactive care at the onset of COVID-19 restrictions, 2) avoidance of healthcare settings and services, and 3) difficulties with remote healthcare encounters. People living with dementia and their carers felt check-up calls were reassuring but limited in scope and content. Some avoided healthcare services, wishing to minimise COVID-19 risk, reduce NHS burden, or encountering technological barriers. Difficulties in remote consultations included lack of prompts to remember problems, dealing with new emerging problems, rescheduling/missed calls, and inclusion of the person with dementia’s voice. Conclusion: While remote consultations could be effective, pro-active calls could be more structured around needs, and consideration should be given to replace non-verbal prompts to describe problems, particularly for new health concerns. In continuing remote consultations, it is important to facilitate engagement with patients living with dementia and their carers to ensure best practice.

scholarly journals Providing person-centered care for patients with complex healthcare needs: A qualitative study

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242418
Author(s):  
Vincent J. T. Peters ◽  
Bert R. Meijboom ◽  
Jan Erik H. Bunt ◽  
Levinus A. Bok ◽  
Marianne W. van Steenbergen ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Chronic Conditions ◽  
Healthcare Professionals ◽  
Healthcare Services ◽  
Structured Interviews ◽  
Healthcare Provision ◽  
Service Architecture ◽  
Children With Down Syndrome ◽  
Healthcare Needs ◽  
Centered Care

Background People with chronic conditions have complex healthcare needs that lead to challenges for adequate healthcare provision. Current healthcare services do not always respond adequately to their needs. A modular perspective, in particular providing visualization of the modular service architecture, is promising for improving the responsiveness of healthcare services to the complex healthcare needs of people with chronic conditions. The modular service architecture provides a comprehensive representation of the components and modules of healthcare provision. In this study, we explore this further in a qualitative multiple case study on healthcare provision for children with Down syndrome in the Netherlands. Methods Data collection for four cases involved 53 semi-structured interviews with healthcare professionals and 21 semi-structured interviews with patients (the parents of children with Down syndrome as proxy). In addition, we gathered data by means of practice observations and analysis of relevant documents. The interviews were audio-recorded, transcribed verbatim and analyzed utilizing the Miles and Huberman approach. Results Our study shows that the perspectives on healthcare provision of professionals and patients differ substantially. The visualization of the modular service architecture that was based on the healthcare professionals’ perspective provided a complete representation of (para)medical outcomes relevant to the professionals’ own discipline. In contrast, the modular service architecture based on the patients’ perspective, which we define as a person-centered modular service architecture, provided a representation of the healthcare service that was primarily based on functional outcomes and the overall wellbeing of the patients. Conclusion Our study shows that visualization of the modular service architecture can be a useful tool to better address the complex needs and requirements of people with a chronic condition. We suggest that a person-centered modular service architecture that focuses on functional outcomes and overall wellbeing, enables increased responsiveness of healthcare services to people with complex healthcare needs and provision of truly person-centered care.

“There is still a perception that homelessness is a housing problem”: devolution, homelessness and health in the UK

2016 ◽  
Vol 19 (2) ◽  
pp. 33-44 ◽  
Author(s):  
Martin Whiteford ◽  
Glenn Simpson
Keyword(s):  
Qualitative Interviews ◽  
Homeless People ◽  
Small Sample ◽  
Issue Salience ◽  
Structured Interviews ◽  
Healthcare Provision ◽  
Policy And Practice ◽  
Content Type ◽  
The Uk ◽  
Comparative Policy

Purpose The purpose of this paper is to provide an exploratory account of the links between devolution, homelessness and health in the UK. Specifically, it focusses on the policy context and governance structures that shape the systems of healthcare for homeless people in London, Scotland, Wales and Northern Ireland. Design/methodology/approach Empirically the paper draws on semi-structured interviews with a small sample of policy and practice actors from the devolved territories. Qualitative interviews were supplemented by a comparative policy analysis of the homelessness and health agenda within the devolved regions. Theoretically, it takes inspiration from Chaney’s concept of the “issue salience of homelessness” and explores the comparative character of healthcare as pertains to homeless people across the devolved territories. Findings The paper provides clear evidence of areas of divergence and convergence in policy and practice between the devolved regions. These features are shown to be strongly mediated by the interplay of two factors: first, the scope and scale of national and local homelessness prevention strategies; and second, intra-national variation in public health responses to homelessness. Originality/value The paper offers considerable insight from a comparative policy perspective into the nature of healthcare provision for homeless people in the devolved regions.

scholarly journals Clinical audit as a tool to optimize contracted private healthcare provision: Testing the waters in resource-deprived Greece

2019 ◽  
Vol 7 ◽  
pp. 205031211983873
Author(s):  
Kyriakos Souliotis ◽  
Christina Golna ◽  
Vasiliki Mantzana ◽  
Sotirios Papaspyropoulos ◽  
Anastasios Koutsovasilis ◽  
...  
Keyword(s):  
Social Insurance ◽  
Best Practice ◽  
Clinical Audit ◽  
Private Insurance ◽  
Healthcare Services ◽  
Evidence Based ◽  
Care Organization ◽  
Healthcare Provision ◽  
Private Healthcare

Background and Aims: Clinical audit is applied to optimize clinical practice and quality of healthcare services while controlling for money spent, critically in resource-deprived settings. This case study reports on the outcomes of a retrospective clinical audit on private hospitalizations, for which reimbursement had been pending by the Health Care Organization for Public Servants (OPAD) in Greece. This case study is the first effort by a social insurance organization in Greece to employ external clinical audit before settling contracted private healthcare charges. Methods: One thousand two hundred hospitalization records were reviewed retrospectively and a fully anonymized clinical audit summary report created for each one of them by a team of clinical audit experts, proposing evidence-based cuts in pending charges where medical services were deemed clinically unnecessary. These audit reports were then collated and analysed to test trends in overcharges among hospitalized insureds per reason for hospitalization. Results: The clinical audit report concluded that 17.4% of a total reimbursement claim of €12,387,702.18 should not be reimbursed, as it corresponded to unnecessary or not fully justifiable according to evidence-based, best practice, medical service provision. The majority of proposed cuts were related to charges for medical devices, which are borne directly by social insurance with no patient or private insurance co-payment. Conclusion: Clinical audit of hospital practice may be a key tool to optimize care provision, address supplier-induced demand and effectively manage costs for national health insurance, especially in circumstances of budgetary constraints, such as in austerity-stricken settings or developing national healthcare systems.

scholarly journals Examining Stakeholder’s Views On Refugee Healthcare Needs, Current Barriers in Accessing Healthcare Services and Future Healthcare Direction in New Zealand: A Qualitative Phenomenological Approach

2021 ◽  
Author(s):  
Bafreen Sherif ◽  
Ahmed Awaisu ◽  
Nadir Kheir
Keyword(s):  
New Zealand ◽  
Health Services ◽  
Qualitative Methodology ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Healthcare Personnel ◽  
Structured Interviews ◽  
Health Seeking ◽  
Healthcare Needs

Abstract Background The annual New Zealand refugee quota was increased to 1500 places from 2020 onwards as a response to the global refugee crisis. The specific healthcare needs of refugees are not clearly understood globally and communication between healthcare providers and refugees remains poor. Methods A phenomenological qualitative methodology was employed to conduct semi-structured interviews among purposively selected stakeholders who work in refugee organisations and relevant bodies in New Zealand. Results The participants indicated the need for a national framework of inclusion, mandating cultural competency training for frontline healthcare and non-healthcare personnel, creation of a national interpretation phone line, and establishing health navigators. Barriers to accessing health services identified included some social determinants of health such as housing and community environment; health-seeking behaviour and health literacy; and social support networks. Future healthcare delivery should focus on capacity building of existing services, including co-design processes, increased funding for refugee-specific health services, and whole government approach. Conclusion Policymakers and refugee organisations and their frontline personnel should seek to address the deficiencies identified in order to provide equitable, timely and cost-effective healthcare services for refugees in New Zealand.

scholarly journals Atrial fibrillation screening: feasible approaches and implementation challenges across Europe

2021 ◽  
Vol 2 (4) ◽  
Author(s):  
D Engler ◽  
C Hanson ◽  
L Desteghe ◽  
G Boriani ◽  
S Z Diederichsen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Healthcare Services ◽  
Sufficient Evidence ◽  
Opportunistic Screening ◽  
Structured Interviews ◽  
Implementation Challenges ◽  
Access To Primary Care ◽  
Public Grant ◽  
Personal Devices

Abstract Background Atrial fibrillation (AF) screening has the potential to increase early detection and possibly reduce complications of AF. Guidelines recommend screening, but the most appropriate approaches are unknown. Purpose We aimed to explore the views of stakeholders across Europe about the opportunities and challenges of implementing four different AF screening scenarios. Method This qualitative study included 21 semi-structured interviews with healthcare professionals and regulators potentially involved in AF screening implementation in nine European countries. Data were analysed using thematic analysis. Results Three themes evolved. 1) Current approaches to screening: there are no national AF screening programmes, with most AF detected in symptomatic patients. Patient-led screening exists via personal devices, creating screening inequity by the reach of screening programmes being limited to those who access healthcare services. 2) Feasibility of screening approaches: single time point opportunistic screening in primary care using single lead ECG devices was considered the most feasible approach and AF screening may be possible in previously unexplored settings such as dentists and podiatrists. Software algorithms may aid identification of patients suitable for screening and telehealth services have the potential to support diagnosis. However, there is a need for advocacy to encourage the use of telehealth to aid AF diagnosis, and training for screening familiarisation and troubleshooting. 3) Implementation requirements: sufficient evidence of benefit is required. National rather than pan-European screening processes must be developed due to different payment mechanisms and health service regulations. There is concern that the rapid spread of wearable devices for heart rate monitoring may increase workload due to false positives in low risk populations for AF. Data security and inclusivity for those without access to primary care or personal devices must be addressed. Conclusions There is an overall awareness of AF screening. Opportunistic screening appears to be most feasible across Europe. Challenges that need to be addressed concern health inequalities, identification of best target groups for screening, streamlined processes, the need for evidence of benefit, and a tailored approach adapted to national realities. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): H2020 Screening Scenarios  Graphical abstract

scholarly journals How do older adults understand and manage distress? A qualitative study

2019 ◽  
Author(s):  
Alice Moult ◽  
Tom Kingstone ◽  
Carolyn Chew-Graham
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Older People ◽  
Help Seeking ◽  
Management Strategies ◽  
Healthcare Services ◽  
Ethical Review ◽  
Structured Interviews ◽  
Management Options ◽  
Community Groups

Abstract Background Anxiety and depression are prevalent in older adults, however, older people may be reluctant to seek medical help and may manage their own mood problems. Due to stigma, older adults are more likely to perceive and/ or recognise their mood problems as distress. Whilst previous literature has focused on how younger adults self-manage mood problems, little research has explored how older people self-manage distress. The study reported here seeks to address this gap through qualitative methods. Methods This study was approved by Keele University’s ethical review panel. Older adults who self-identified as distressed, depressed or anxious within the previous 12 months were recruited from community groups in North Staffordshire, England. Data were generated through semi-structured interviews and analysed thematically using constant comparison methods. A public and patient involvement and engagement group contributed to development of the research questions and methods, and offered their perspectives on the findings. Results Data saturation was achieved after 18 interviews. Key themes were: experiences of distress, actions taken, help-seeking from healthcare services and perceptions of treatments offered in primary care. Various forms of loss contributed to participants’ distress. Participants initiated their own self-management strategies which included: pursuing independent activities, seeking social support and attending community groups and church. Five participants reported having consulted a GP when distressed but described a lack of acceptable treatments offered. Conclusions To support older adults who are distressed, primary care healthcare professionals need to explore patients’ existing ways of managing mood problems, provide information about a range of management options and consider the use of sign-posting older adults to community resources.

scholarly journals The impact of the Affordable Care Act on patient coverage and access to care: perspectives from FQHC administrators in Arizona, California and Texas

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Angelo Ercia
Keyword(s):  
Access To Care ◽  
Affordable Care Act ◽  
Health Care Services ◽  
Healthcare Services ◽  
Structured Interviews ◽  
Care Services ◽  
Healthcare Needs ◽  
The Affordable Care Act ◽  
Insured Patients ◽  
The Impact

Abstract Background The Affordable Care Act (ACA) enabled millions of people to gain coverage that was expected to improve access to healthcare services. However, it is unclear the extent of the policy’s impact on Federally Qualified Health Centers (FQHC) and the patients they served. This study sought to understand FQHC administrators’ views on the ACA’s impact on their patient population and organization. It specifically explores FQHC administrators’ perspective on 1) patients’ experience with gaining coverage 2) their ability to meet patients’ healthcare needs. Methods Twenty-two semi-structured interviews were conducted with administrators from FQHCs in urban counties in 2 Medicaid-expanded states (Arizona and California) and 1 non-expanded state (Texas). An inductive thematic analysis approach was used to analyze the interview data. Results All FQHC administrators reported uninsured patients were more likely to gain coverage from Medicaid than from private health insurance. Insured patients generally experienced an improvement in accessing healthcare services but depended on their plan’s covered services, FQHCs’ capacity to meet demand, and specialist providers’ willingness to accept their coverage type. Conclusion Gaining coverage helped improved newly insured patients’ access to care, but limitations remained. Additional policies are required to better address the gaps in the depth of covered services in Medicaid and the most affordable PHI plans and capacity of providers to meet demand to ensure beneficiaries can fully access the health care services they need.

Government reports versus offenders’ experiences: toward the resolution of discrepancies in healthcare and healthcare delivery

2015 ◽  
Vol 11 (4) ◽  
pp. 225-242 ◽  
Author(s):  
Pegah Memarpour ◽  
Rose Ricciardelli ◽  
Pauline Maasarjian
Keyword(s):  
Mental Health ◽  
Prison Population ◽  
Healthcare Delivery ◽  
Healthcare Services ◽  
Physical And Mental Health ◽  
Healthcare Provision ◽  
Content Type ◽  
Former Prisoners ◽  
Healthcare Needs

Purpose – Canadian literature on federal correctional institutions and prison living indicate a shortage inadequate and available healthcare services to meet the needs of the prison population, despite prisoners higher rates of health challenges (e.g. mental health, addictions, HIV/AIDS) in comparison to the general population. With fewer resources, concerns arise about the delivery, quantity, and quality of penal healthcare provision. Thus, the authors examines former prisoners’ experiences of, in comparison to government reports on, wait-times, and request processes for healthcare services, as well as issues of access, quality of interactions with healthcare professionals and the regulations and policies governing healthcare provision. The paper aims to discuss these issues. Design/methodology/approach – The authors compare data gathered from interviews with 56 former-federal prisoners with publicly available Correctional Services Canada reports on healthcare delivery, staff-prisoner interactions, programmes and services, and overall physical and mental health to identify consistencies and inconsistencies between the government’s and former prisoners’ understandings of penal healthcare. Findings – Discrepancies exist between prisoners reported experiences of healthcare provision and government reports. Prisoners are dissatisfied with healthcare provision in more secure facilities or when they feel their healthcare needs are not met yet become more satisfied in less secure institutions or when their needs are eventually met. Originality/value – Theories of administrative control frame the analyses, including discrepancies between parolee experiences and Correctional Service Canada reports. Policy recommendations to improve healthcare provision are highlighted.

scholarly journals Navigating the U.S. health insurance landscape for children with rare diseases: a qualitative study of parents’ experiences

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Tai L. S. Pasquini ◽  
Sarah L. Goff ◽  
Jennifer M. Whitehill
Keyword(s):  
Health Insurance ◽  
Rare Diseases ◽  
Muscular Atrophy ◽  
Healthcare Services ◽  
Healthcare Team ◽  
Drug Status ◽  
Structured Interviews ◽  
Eligibility Criteria ◽  
Health Insurance Status ◽  
Healthcare Needs

Abstract Background Parents of children with rare diseases often face uncertainty about diagnosis, treatment, and costs associated with healthcare for their child. Health insurance status impacts each of these areas, but no U.S. study has explored parents’ perceptions of the health insurance impacts on their child’s care. This study aimed to qualitatively explore how these parents navigate the complex health insurance system for their children and their experiences in doing so. Methods Semi-structured interviews were conducted with parents of children with metachromatic leukodystrophy (MLD) and spinal muscular atrophy (SMA), chosen for specific disease characteristics and orphan drug status. Participants were recruited via e-mail through patient advocacy organizations between September and December 2018. Interviews were conducted via Skype, were recorded, and professionally transcribed. Modified grounded theory was utilized as a methodology to analyze transcripts in an iterative process to determine themes and sub-themes based on participant described experiences. Results Major themes and subthemes that emerged across the 15 interviews included: (1) difficulties obtaining secondary insurance based on state eligibility criteria; (2) difficulty accessing needed healthcare services; and (3) need for repeated interactions with insurance representatives. The absence of clearly documented or widely recognized clinical guidelines exacerbated the difficulty accessing care identified as necessary by their healthcare team, such as therapy and equipment. An explanatory model for parent’s experiences was developed from the themes and subthemes. The model includes the cyclical nature of interacting with insurance for redundant reauthorizations and the outside support and financial assistance that is often necessary to address their child’s healthcare needs. Conclusions With complex health conditions, small setbacks can become costly and disruptive to the health of the child and the life of the family. This study suggests that patients with rare diseases may benefit from time limits for processing coverage decisions, increasing transparency in the claims and preauthorization processes, and more expansive authorizations for on-going needs. Additional studies are needed to understand the full scope of barriers and to inform policies that can facilitate better access for families living with rare diseases.

scholarly journals Why do challenges still exist in primary care for patients with spinal cord injury?

2020 ◽  
Vol 9 (4) ◽  
pp. 111-137
Author(s):  
Colleen McMillan ◽  
James Milligan ◽  
Loretta M. Hillier ◽  
Craig Bauman ◽  
Lindsay Donaldson ◽  
...  
Keyword(s):  
Primary Care ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Qualitative Interviews ◽  
Self Management ◽  
Care Needs ◽  
Optimal Care ◽  
Healthcare Needs ◽  
Cord Injury ◽  
Family Practice Physicians

Despite having high healthcare needs, individuals with spinal cord injury (SCI) receive suboptimal primary care; they are less likely than able-bodied persons to receive preventive care and more likely to have unmet health care needs. The aim of this mixed quantitative (surveys) and qualitative (interviews) study was to gather primary care health provider and rehabilitation specialists’ perspectives on why these challenges persist despite the increasing body of evidence identifying delivery service gaps. Surveys were completed by 12 family physicians who referred individuals with SCI to an interprofessional primary care mobility clinic. Interviews were completed with eight SCI rehabilitation providers. Questions in both the survey and interviews were asked related to the barriers to the provision of optimal care for SCI, potential solutions, and preferred methods for knowledge dissemination. Skill and attitudinal reasons were offered for the lack of evidence to practice transfer including: the absence of patient self-management, poor access to specialists, lack of education for family practice physicians, fragmentation of community resources and co-ordination upon hospital discharge. Solutions offered included greater patient self-management, better access to specialists, specialized primary care services and provision of SCI guidelines and protocols. Participant explanations and solutions were then analyzed through a social disability lens to see if new understandings could be identified to explain the lack of uptake from research findings to clinical practice for this underserviced vulnerable population.

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