Supporting continuity of care between prison and the community for women in prison: a medical record review

2017 ◽  
Vol 41 (3) ◽  
pp. 268 ◽  
Author(s):  
Penelope Abbott ◽  
Parker Magin ◽  
Sanja Lujic ◽  
Wendy Hu
Keyword(s):  
Health Care ◽  
Health Services ◽  
Community Health ◽  
Health Information ◽  
Continuity Of Care ◽  
Medical Records ◽  
Information Transfer ◽  
Health Needs ◽  
Care Providers ◽  
Women In Prison

Objectives The aim of the present study was to examine health information transfer and continuity of care arrangements between prison and community health care providers (HCPs) for women in prison. Methods Medical records of women released from New South Wales prisons in 2013–14 were reviewed. Variables included health status, health care in prison and documented continuity of care arrangements, including information transfer between prison and community. Associations were measured by adjusted odds ratios (AORs) using a logistic regression model. Text from the records was collected as qualitative data and analysed to provide explanatory detail. Results In all, 212 medical records were systematically sampled and reviewed. On prison entry, information was requested from community HCPs in 53% of cases, mainly from general practitioners (GPs, 39%), and was more likely to have occurred for those on medication (AOR 7.08; 95% confidence interval (CI) 3.71, 13.50) or with schizophrenia or other psychotic disorders (AOR 4.20; 95% CI 1.46, 12.11). At release, continuity of care arrangements and health information transfer to GPs were usually linked to formal pre-release healthcare linkage programs. Outside these programs, only 20% of records had evidence of such continuity of care at release, with the odds higher for those on medication (AOR 8.28; 95% CI 1.85, 37.04) and lower for women with problematic substance misuse (AOR 0.32; 95% CI 0.14, 0.72). Few requests for information were received after individuals had been released from custody (5/212; two from GPs). Conclusion Increased health information transfer to community HCPs is needed to improve continuity of care between prison and community. What is known about the topic? Many women in prison have high health needs. Health and well being are at further risk at the time of transition between prison and community. What does this paper add? This study provides evidence that outside formal programs, which are currently available only for a minority of women, continuity of care arrangements and transfer of health information do not usually occur when women leave prison. Pragmatic choices about continuity of care at the interface between prison and community may have been made, particularly focusing on medication continuity. Barriers to continuity of care and ways forward are suggested. What are the implications for practitioners? Siloing of health care delivered within prison health services through lack of continuity of care at release is wasteful, both in terms of healthcare costs and lost opportunities to achieve health outcomes in a vulnerable population with high health needs. There is need for an increased focus on continuity of care between prison and community health services, HCP support and training and expansion of pre-release planning and healthcare linkage programs to assist larger numbers of women in prison.

Healthcare delivery for women in prison: a medical record review

2016 ◽  
Vol 22 (6) ◽  
pp. 523 ◽  
Author(s):  
Penelope Abbott ◽  
Parker Magin ◽  
Wendy Hu
Keyword(s):  
Health Care ◽  
Health Services ◽  
Medical Record ◽  
Healthcare Delivery ◽  
High Risk Group ◽  
Health Needs ◽  
Medical Record Review ◽  
Wide Range ◽  
Women In Prison ◽  
Record Review

When women come into prison, many have unmet health needs. In this study we examine the health care provided to women in prison and their identified health needs, and discuss opportunities for improved healthcare delivery. We undertook a medical record review of women released from a minimum 6-week period of incarceration in New South Wales correctional centres between May 2013 and January 2014. Records from 231 periods of incarceration were reviewed. At reception, 52% of women were identified as having anxiety or depression. Hearing health was not documented despite 30% of records being of women from an Aboriginal and Torres Strait Islander background, a high-risk group for whom hearing screening is recommended. Most women had multiple in-prison clinical contacts, including interactions with general and specialised nurses (97%), general practitioners (65%) and psychiatrists (35%). At release, 49% were on psychotropic medication and most required ongoing management for: mental health (71%), substance misuse (65%) and physical health (61%) problems. External specialist appointments were pending in 7% at release. Health management plans generated in prison were not always completed before release for reasons including custodial factors and waits for hospital-based appointments. Provision of effective health care in prison requires improved integration with community health services, including timely access to a wide range of health services while women are in prison, and continuity of care at release.

scholarly journals Integration and continuity of primary care: polyclinics and alternatives – a patient-centred analysis of how organisation constrains care co-ordination

2015 ◽  
Vol 3 (35) ◽  
pp. 1-148 ◽  
Author(s):  
Rod Sheaff ◽  
Joyce Halliday ◽  
John Øvretveit ◽  
Richard Byng ◽  
Mark Exworthy ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Services ◽  
Continuity Of Care ◽  
Primary Care Providers ◽  
Community Health Services ◽  
Managerial Discretion ◽  
Care Providers ◽  
And Performance ◽  
Study Sites

BackgroundAn ageing population, the increasing specialisation of clinical services and diverse health-care provider ownership make the co-ordination and continuity of complex care increasingly problematic. The way in which the provision of complex health care is co-ordinated produces – or fails to produce – six forms of continuity of care (cross-sectional, longitudinal, flexible, access, informational and relational). Care co-ordination is accomplished by a combination of activities by patients themselves; provider organisations; care networks co-ordinating the separate provider organisations; and overall health-system governance. This research examines how far organisational integration might promote care co-ordination at the clinical level.ObjectivesTo examine (1) what differences the organisational integration of primary care makes, compared with network governance, to horizontal and vertical co-ordination of care; (2) what difference provider ownership (corporate, partnership, public) makes; (3) how much scope either structure allows for managerial discretion and ‘performance’; (4) differences between networked and hierarchical governance regarding the continuity and integration of primary care; and (5) the implications of the above for managerial practice in primary care.MethodsMultiple-methods design combining (1) the assembly of an analytic framework by non-systematic review; (2) a framework analysis of patients’ experiences of the continuities of care; (3) a systematic comparison of organisational case studies made in the same study sites; (4) a cross-country comparison of care co-ordination mechanisms found in our NHS study sites with those in publicly owned and managed Swedish polyclinics; and (5) the analysis and synthesis of data using an ‘inside-out’ analytic strategy. Study sites included professional partnership, corporate and publicly owned and managed primary care providers, and different configurations of organisational integration or separation of community health services, mental health services, social services and acute inpatient care.ResultsStarting from data about patients’ experiences of the co-ordination or under-co-ordination of care, we identified five care co-ordination mechanisms present in both the integrated organisations and the care networks; four main obstacles to care co-ordination within the integrated organisations, of which two were also present in the care networks; seven main obstacles to care co-ordination that were specific to the care networks; and nine care co-ordination mechanisms present in the integrated organisations. Taking everything into consideration, integrated organisations appeared more favourable to producing continuities of care than did care networks. Network structures demonstrated more flexibility in adding services for small care groups temporarily, but the expansion of integrated organisations had advantages when adding new services on a longer term and a larger scale. Ownership differences affected the range of services to which patients had direct access; primary care doctors’ managerial responsibilities (relevant to care co-ordination because of their impact on general practitioner workload); and the scope for doctors to develop special interests. We found little difference between integrated organisations and care networks in terms of managerial discretion and performance.ConclusionsOn balance, an integrated organisation seems more likely to favour the development of care co-ordination and, therefore, continuities of care than a system of care networks. At least four different variants of ownership and management of organisationally integrated primary care providers are practicable in NHS-like settings. Future research is therefore required, above all to evaluate comparatively the different techniques for coordinating patient discharge across the triple interface between hospitals, general practices and community health services; and to discover what effects increasing the scale and scope of general practice activities will have on continuity of care.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Online Medical Record Nonuse Among Patients: Data Analysis Study of the 2019 Health Information National Trends Survey

10.2196/24767 ◽  
2021 ◽  
Vol 23 (2) ◽  
pp. e24767
Author(s):  
Safa Elkefi ◽  
Zhongyuan Yu ◽  
Onur Asan
Keyword(s):  
Health Care ◽  
Health Information ◽  
Medical Record ◽  
Health Care Providers ◽  
Medical Records ◽  
Health Care Disparities ◽  
Care Providers ◽  
Chi Square ◽  
National Trends ◽  
Privacy Issues

Background Online medical records are being used to organize processes in clinical and outpatient settings and to forge doctor-patient communication techniques that build mutual understanding and trust. Objective We aimed to understand the reasons why patients tend to avoid using online medical records and to compare the perceptions that patients have of online medical records based on demographics and cancer diagnosis. Methods We used data from the Health Information National Trends Survey Cycle 3, a nationally representative survey, and assessed outcomes using descriptive statistics and chi-square tests. The patients (N=4328) included in the analysis had experienced an outpatient visit within the previous 12 months and had answered the online behavior question regarding their use of online medical records. Results Patients who were nonusers of online medical records consisted of 58.36% of the sample (2526/4328). The highest nonuser rates were for patients who were Hispanic (460/683, 67.35%), patients who were non-Hispanic Black (434/653, 66.46%), and patients who were older than 65 years (968/1520, 63.6%). Patients older than 65 years were less likely to use online medical records (odds ratio [OR] 1.51, 95% CI 1.24-1.84, P<.001). Patients who were White were more likely to use online medical records than patients who were Black (OR 1.71, 95% CI 1.43-2.05, P<.001) or Hispanic (OR 1.65, 95% CI 1.37-1.98, P<.001). Patients who were diagnosed with cancer were more likely to use online medical records compared to patients with no cancer (OR 1.31, 95% CI 1.11-1.55, 95% CI 1.11-1.55, P=.001). Among nonusers, older patients (≥65 years old) preferred speaking directly to their health care providers (OR 1.76, 95% CI 1.35-2.31, P<.001), were more concerned about privacy issues caused by online medical records (OR 1.79, 95% CI 1.22-2.66, P<.001), and felt uncomfortable using the online medical record systems (OR 10.55, 95% CI 6.06-19.89, P<.001) compared to those aged 18-34 years. Patients who were Black or Hispanic were more concerned about privacy issues (OR 1.42, 1.09-1.84, P=.007). Conclusions Studies should consider social factors such as gender, race/ethnicity, and age when monitoring trends in eHealth use to ensure that eHealth use does not induce greater health status and health care disparities between people with different backgrounds and demographic characteristics.

scholarly journals Online Medical Record Nonuse Among Patients: Data Analysis Study of the 2019 Health Information National Trends Survey (Preprint)

2020 ◽  
Author(s):  
Safa Elkefi ◽  
Zhongyuan Yu ◽  
Onur Asan
Keyword(s):  
Health Care ◽  
Health Information ◽  
Medical Record ◽  
Health Care Providers ◽  
Medical Records ◽  
Health Care Disparities ◽  
Care Providers ◽  
Chi Square ◽  
National Trends ◽  
Privacy Issues

BACKGROUND Online medical records are being used to organize processes in clinical and outpatient settings and to forge doctor-patient communication techniques that build mutual understanding and trust. OBJECTIVE We aimed to understand the reasons why patients tend to avoid using online medical records and to compare the perceptions that patients have of online medical records based on demographics and cancer diagnosis. METHODS We used data from the Health Information National Trends Survey Cycle 3, a nationally representative survey, and assessed outcomes using descriptive statistics and chi-square tests. The patients (N=4328) included in the analysis had experienced an outpatient visit within the previous 12 months and had answered the online behavior question regarding their use of online medical records. RESULTS Patients who were nonusers of online medical records consisted of 58.36% of the sample (2526/4328). The highest nonuser rates were for patients who were Hispanic (460/683, 67.35%), patients who were non-Hispanic Black (434/653, 66.46%), and patients who were older than 65 years (968/1520, 63.6%). Patients older than 65 years were less likely to use online medical records (odds ratio [OR] 1.51, 95% CI 1.24-1.84, <i>P</i>&lt;.001). Patients who were White were more likely to use online medical records than patients who were Black (OR 1.71, 95% CI 1.43-2.05, <i>P</i>&lt;.001) or Hispanic (OR 1.65, 95% CI 1.37-1.98, <i>P</i>&lt;.001). Patients who were diagnosed with cancer were more likely to use online medical records compared to patients with no cancer (OR 1.31, 95% CI 1.11-1.55, 95% CI 1.11-1.55, <i>P</i>=.001). Among nonusers, older patients (≥65 years old) preferred speaking directly to their health care providers (OR 1.76, 95% CI 1.35-2.31, <i>P</i>&lt;.001), were more concerned about privacy issues caused by online medical records (OR 1.79, 95% CI 1.22-2.66, <i>P</i>&lt;.001), and felt uncomfortable using the online medical record systems (OR 10.55, 95% CI 6.06-19.89, <i>P</i>&lt;.001) compared to those aged 18-34 years. Patients who were Black or Hispanic were more concerned about privacy issues (OR 1.42, 1.09-1.84, <i>P</i>=.007). CONCLUSIONS Studies should consider social factors such as gender, race/ethnicity, and age when monitoring trends in eHealth use to ensure that eHealth use does not induce greater health status and health care disparities between people with different backgrounds and demographic characteristics. CLINICALTRIAL

Health Informatics and Community Health: Support for Patients as Collaborators in Care

1999 ◽  
Vol 38 (04/05) ◽  
pp. 274-278 ◽  
Author(s):  
P. F. Brennan
Keyword(s):  
Health Care ◽  
Community Health ◽  
Health Information ◽  
Health Informatics ◽  
Information Technologies ◽  
Community Health Care ◽  
Care Providers ◽  
Information Discovery ◽  
Lay Persons ◽  
Communication Needs

AbstractHealth informatics has much to offer community health care. Computer networks and telecommunications provide particular support that can enhance the collaboration among clinicians, care providers and patients. Special-purpose computer tools referred to as Consumer Health Informatics (CHI) represent the application of computer and information technologies specifically to support the health information and communication needs of patients and lay persons. Research projects like ComputerLink and CHESS demonstrate that CHI is acceptable to patients and promotes self-care and disease management. Three grand challenges must be faced to insure realization of the promise of health informatics to community health care: development of knowledge management and information discovery tools for patients, insurance of health information literacy for all persons, and re-engineering clinical practice to capitalize on patients as full partners in health care.

scholarly journals Ontwikkeling Van Omvattende Gesondheidsdienste in DieSelfregerende Swart Gebiede In Suider-Afrika

Curationis ◽  
1978 ◽  
Vol 1 (1) ◽  
Author(s):  
J.P. Roux
Keyword(s):  
Health Care ◽  
Health Services ◽  
Community Health ◽  
Care Delivery ◽  
Social Process ◽  
Social Function ◽  
Health Needs ◽  
Basic Health ◽  
Community Health Centres ◽  
Health Centres

In the development of health services in the selfgoverning Black territories of South Africa cognisance was taken of the modern holistic concept of health care delivery. The comprehensive hospital-centric health services in these territories have been supplemented by the introduction of community health centres with a broad spectrum of available services. These community health centres make provision for the basic health needs of the different communities and stimulate community participation — a fundamental requirement for community development. Training facilities for nurses fulfil modern requirements but should be adapted to the health needs of developing communities. Conventional curative services are unlikely to meet the basic health needs of all people. The emphasis should be on primary health care — a concept embracing health and welfare in its entirety and not restricted to the provision of medical care or personal health services. Community health development is essentially a social process that should start off with the acceptance of the social function of health and should ensure that health technology is developed and applied in harmony with this social function.

scholarly journals Perception and Willingness to Maintain Continuity of Care by Parents of Children with Asthma in Taiwan

2021 ◽  
Vol 18 (7) ◽  
pp. 3600
Author(s):  
Christy Pu ◽  
Yu-Chen Tseng ◽  
Gau-Jun Tang ◽  
Yen-Hsiung Lin ◽  
Chien-Heng Lin ◽  
...  
Keyword(s):  
Health Care ◽  
Willingness To Pay ◽  
Health Care Providers ◽  
Continuity Of Care ◽  
Care Providers ◽  
Exact Matching ◽  
Extra Effort ◽  
Referral Management ◽  
Children With Asthma ◽  
Outpatient Departments

To investigate caregivers’ attitudes toward continuity of care (COC) and their willingness to maintain continuity for their children with asthma under a national health insurance (NHI) system without strict referral management. We sampled 825 individuals from six pediatric outpatient departments in different parts of Taiwan from 2017 to 2018. We used a contingent valuation with a payment card method. Post-stratification weighting adjustment and coarsened exact matching were utilized. Multiple logistic regression was used to compare the willingness to pay and spend extra time maintaining continuity by parents. More than 80% of caregivers in the asthma group believed having a primary pediatrician was important for children’s health. Only 27.5% and 15.8% of caregivers in the asthma and control groups, respectively, believed changing pediatricians would negatively affect therapeutic outcomes. Regression analysis showed that the predicted willingness to pay for the asthma and non-asthma groups were NT$508 (SD = 196) and NT$402 (SD = 172), respectively, and there was a significant positive dose–response relationship between household income and willingness to pay for maintaining health care provider continuity. Caregivers’ free choices among health care providers may reduce willingness to spend extra effort to maintain high COC. Caregivers should be educated on the importance of COC.

Patients' Perceptions of Different Information Exchange Mechanisms: An Exploratory Study in the United States

2020 ◽  
Vol 59 (04/05) ◽  
pp. 162-178
Author(s):  
Pouyan Esmaeilzadeh
Keyword(s):  
United States ◽  
Health Care ◽  
Health Information ◽  
Health Care Providers ◽  
Information Exchange ◽  
The United States ◽  
Exchange Mechanism ◽  
Care Providers ◽  
Security Risks ◽  
Direct Exchange

Abstract Background Patients may seek health care services from various providers during treatment. These providers could serve in a network (affiliated) or practice separately (unaffiliated). Thus, using secure and reliable health information exchange (HIE) mechanisms would be critical to transfer sensitive personal health information (PHI) across distances. Studying patients' perceptions and opinions about exchange mechanisms could help health care providers build more complete HIEs' databases and develop robust privacy policies, consent processes, and patient education programs. Objectives Due to the exploratory nature of this study, we aim to shed more light on public perspectives (benefits, concerns, and risks) associated with the four data exchange practices in the health care sector. Methods In this study, we compared public perceptions and expectations regarding four common types of exchange mechanisms used in the United States (i.e., traditional, direct, query-based, patient-mediated exchange mechanisms). Traditional is an exchange through fax, paper mailing, or phone calls, direct is a provider-to-provider exchange, query-based is sharing patient data with a central repository, and patient-mediated is an exchange mechanism in which patients can access data and monitor sharing. Data were collected from 1,624 subjects using an online survey to examine the benefits, risks, and concerns associated with the four exchange mechanisms from patients' perspectives. Results Findings indicate that several concerns and risks such as privacy concerns, security risks, trust issues, and psychological risks are raised. Besides, multiple benefits such as access to complete information, communication improvement, timely and convenient information sharing, cost-saving, and medical error reduction are highlighted by respondents. Through consideration of all risks and benefits associated with the four exchange mechanisms, the direct HIE mechanism was selected by respondents as the most preferred mechanism of information exchange among providers. More than half of the respondents (56.18%) stated that overall they favored direct exchange over the other mechanisms. 42.70% of respondents expected to be more likely to share their PHI with health care providers who implemented and utilized a direct exchange mechanism. 43.26% of respondents believed that they would support health care providers to leverage a direct HIE mechanism for sharing their PHI with other providers. The results exhibit that individuals expect greater benefits and fewer adverse effects from direct HIE among health care providers. Overall, the general public sentiment is more in favor of direct data transfer. Our results highlight that greater public trust in exchange mechanisms is required, and information privacy and security risks must be addressed before the widespread implementation of such mechanisms. Conclusion This exploratory study's findings could be interesting for health care providers and HIE policymakers to analyze how consumers perceive the current exchange mechanisms, what concerns should be addressed, and how the exchange mechanisms could be modified to meet consumers' needs.

scholarly journals Patient experience surveys for children’s community health services: A scoping review

2021 ◽  
pp. 136749352110058
Author(s):  
Helen J Nelson ◽  
Catherine Pienaar ◽  
Anne M Williams ◽  
Ailsa Munns ◽  
Katie McKenzie ◽  
...  
Keyword(s):  
Health Care ◽  
Health Services ◽  
Community Health ◽  
Patient Experience ◽  
Scoping Review ◽  
Emotional Support ◽  
Community Health Services ◽  
Experience Of Care ◽  
Healthcare Experience

Patient experience surveys have a user focus and measure the quality of person-centered health care for hospital inpatients and consumers of community health services, providing a governance process to evaluate the quality of care and to action improvement. Experience of care has been described as effective communication, respect and dignity, and emotional support. Measurement criteria for these domains are not standardized, leading to inconsistent reporting of patient experience. The objective of this scoping review was to synthesize evidence for measuring experience of care in children’s community health services using the Joanna Briggs Institute framework for scoping review method. Three parent-reported surveys met the inclusion criteria, and 50 survey items were assessed by expert reviewers for fit to domains of healthcare experience. Conceptual domains of parent experience in children’s community health services included respect and dignity, effective communication, and emotional support. A gap was identified, in that few items in identified surveys measured emotional support. This contribution will promote consistent reporting of healthcare experience, informing policy and practice for person-centered health care.

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