Thinking outside the system: the integrated care experience in Queensland, Australia

2019 ◽  
Vol 25 (4) ◽  
pp. 303 ◽  
Author(s):  
Linda Mundy ◽  
Kaye Hewson
Keyword(s):  
Health Care ◽  
Chronic Disease ◽  
Integrated Care ◽  
Complex Disease ◽  
Wide Spectrum ◽  
Ageing Population ◽  
Patient Journey ◽  
Developmental Issues ◽  
Care Experience ◽  
Seed Funding

Health policy-makers are faced with a demand for health care that exceeds supply, driven in part by an ageing population and an increased prevalence of chronic disease. An integrated ‘people-centred’ model of care across primary, secondary and tertiary health care can strengthen the health system by streamlining services to improve the patient journey and outcomes. Integrated care offers an opportunity to reduce admissions and re-admissions to hospitals, reduce presentations to emergency departments and improve the capacity of outpatient clinics while delivering better outcomes to patients. Queensland’s $35 million Integrated Care Innovation Fund (ICIF) has provided seed funding to 24 projects covering a wide spectrum of chronic disease management and complex disease. Programs such as the ICIF offer an opportunity to provide a new approach to caring for vulnerable populations such as the frail and elderly; children with behavioural and developmental issues; children in out-of-home care; rural and remote populations; and people with mental health issues, whose care runs the risk of ‘falling through the cracks’ with conventional healthcare approaches.

scholarly journals Understanding patient journey in ulcerative colitis prior to biologic initiation: a 5-year exploration

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yiting Wang ◽  
Rupa Makadia ◽  
Christopher Knoll ◽  
Jill Hardin ◽  
Erica A. Voss ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Health Care ◽  
Health Care Utilization ◽  
Corticosteroid Treatment ◽  
Biologic Agent ◽  
Care Utilization ◽  
Biologic Treatment ◽  
Patient Journey ◽  
Care Experience ◽  
Oral Corticosteroids

Abstract Background There has been a more pronounced shift toward earlier, more aggressive therapies in Crohn’s disease than in ulcerative colitis (UC). The aim of this study was to describe the pre-biologic treatment and health care experience, including co-morbidities and overall health care utilization, for UC patients who initiated biologic therapies, in the 5 years prior to the initiation of the first biologic agent. Methods UC patients who initiated a biologic agent approved for UC between 9/15/2005 and 1/30/2018 were identified from the IBM® MarketScan® Commercial Database, a large US database. The date of the first recorded UC biologic exposure was defined as the index date, and ≥ 5 years of pre-index records were required to evaluate patients’ treatment, disease progression and overall health care utilization prior to initiating biologic agents. Results Among the 1891 eligible patients, treatment with oral corticosteroids, 5-aminosalicylates, and other non-biologic immunomodulators, all increased progressively across the 5 years prior to the index. From within year-five to within year-one prior to the index, the median duration of oral corticosteroid treatment increased from 34 to 88 days per year and the proportion of patients who experienced more extensive/pancolitis disease increased from 16 to 59%. Overall, the frequency of all-cause health care visits also increased. Conclusions Patients with UC experienced increasing morbidity and treatment burden in the 5 years prior to initiating biologic therapy. To achieve reduced corticosteroids in UC management, better risk stratification is needed to help identify patients for more timely biologic treatment.

Integrated Pediatric Health Care in Pennsylvania: A Survey of Primary Care and Behavioral Health Providers

2018 ◽  
Vol 58 (2) ◽  
pp. 213-225 ◽  
Author(s):  
David J. Kolko ◽  
Eunice Torres ◽  
Kevin Rumbarger ◽  
Everette James ◽  
Renee Turchi ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Behavioral Health ◽  
Integrated Care ◽  
Primary Care Physicians ◽  
Empirical Literature ◽  
Health Providers ◽  
Pediatric Health ◽  
Care Experience ◽  
Pediatric Health Care

This study reports on a statewide survey of medical and behavioral health professionals to advance the knowledge base on the benefits and obstacles to delivering integrated pediatric health care. Surveys distributed in 3 statewide provider networks were completed by 110 behavioral health specialists (BHSs) and 111 primary care physicians (PCPs). Survey content documented their perceptions about key services, benefits, barriers, and needed opportunities related to integrated care. Factor analyses identified 8 factors, and other items were examined individually. We compared responses by specialty group (BHS vs PCP) and integrated care experience (no vs yes). The findings revealed differences across domains by specialty subgroup. In several cases, BHS (vs PCP) respondents, especially those with integrated care experience, reported lower benefits, higher barriers, and fewer resource requests. The implications of these results for enhancing care integration development, delivery, training, and research are discussed along with the study’s limitations and empirical literature.

scholarly journals Caring Together 2 Breathe Easy: an integrated care trial to reduce readmission and improve the health care experience for people with COPD

2018 ◽  
Vol 18 (s1) ◽  
pp. 131
Author(s):  
Wayne George Middleton ◽  
Donna Ward ◽  
Simon Finnigan ◽  
John Adie ◽  
Chrissie Norton
Keyword(s):  
Health Care ◽  
Integrated Care ◽  
Care Experience ◽  
Health Care Experience

Transdisciplinary Challenges for Health Service Research and Evaluation in General Practice: The Case of Chronic Disease Management

1997 ◽  
Vol 3 (3) ◽  
pp. 32 ◽  
Author(s):  
Carmel Martin ◽  
Chris Peterson
Keyword(s):  
Health Care ◽  
General Practice ◽  
Chronic Disease ◽  
Chronic Illness ◽  
Wide Spectrum ◽  
Clinical Care ◽  
Practice Research ◽  
Service Research ◽  
Multidisciplinary Teams ◽  
Objective Evidence

Changing expectations of general practice are driven by diverse forces including an increased demand for chronic care. General practice care of chronic disease and illness straddles a wide spectrum of disciplines. However, political, health care, and research structures maintain discrete discipline orientated research. 'Objective' evidence, from quantitative paradigms, about disease, treatment and services predominate over 'subjective' evidence based upon understandings, for example, about how people live with chronic illness. Transdisciplinary approaches are desirable to provide synthesis of evidence across these paradigms to inform and evaluate the complexity of generalism in clinical care. However, transdisciplinarity is only feasible if it both respects disciplinary traditions, yet challenges underlying assumptions about knowledge creation. Inductive processes and open rather than closed systems provide mechanisms for this process. Transdisciplinarity needs to operate at levels of abstraction where there is commonality, typically at the level of the research question and the resultant formulation of theory and knowledge to inform policy or practice. Multidisciplinary teams and transdisciplinary trained researchers with meta-theoretical frameworks that facilitate these conceptual and practicable linkages are discussed. Major challenges to transdisciplinary approaches remain, not only because of their newness, but because of different theoretical traditions, and with the current structures of disciplines, evaluation and research funding and training. We need reflexive integrated general practice research in response to the ever-changing and multi-dimensional nature of health care. Despite fluidity and evolution, research processes that are mainly driven by expediency, may not best serve the needs of those with chronic illness or general practice.

scholarly journals Understanding Patient Journey in Ulcerative Colitis Prior to Biologic Initiation: A 5-Year Exploration

2020 ◽  
Author(s):  
Yiting Wang ◽  
Rupa Makadia ◽  
Christopher Knoll ◽  
Jill Hardin ◽  
Erica Voss ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Health Care ◽  
Health Care Utilization ◽  
Biologic Agent ◽  
Care Utilization ◽  
Sustained Remission ◽  
Biologic Treatment ◽  
Patient Journey ◽  
Care Experience ◽  
Oral Corticosteroids

Abstract Background There has been a more pronounced shift toward earlier, more aggressive therapies in Crohn’s disease than in ulcerative colitis (UC). The aim of this study was to describe the pre-biologic treatment and health care experience, including co-morbidities and overall health care utilization, for UC patients who initiated biologic therapies in the five years prior to the initiation of the first biologic agent.MethodsUC patients who initiated a biologic agent approved for UC between 9/15/2005 and 1/30/2018 were identified from the IBM® MarketScan® Commercial claims database. The date of the first recorded UC biologic exposure was defined as the index date, and ≥ 5 years of pre-index records were required to evaluate patients’ treatment, disease progression and overall health care utilization prior to initiating biologic agents.ResultsAmong the 1891 eligible patients, treatment with oral corticosteroids, 5-aminosalicylates, and other non-biologic immunomodulators all increased progressively across the five years prior to the index. From within year-five to within year-one prior to the index, the median duration of oral corticosteroids increased from 34 to 88 days per year and the proportion of patients who experienced more extensive/pancolitis disease increased from 16% to 59%. Overall, the frequency of all-cause health care visits also increased.ConclusionsPatients with UC experienced increasing morbidity and treatment burden in the five years prior to initiating biologic therapy. To achieve sustained remission and mucosal healing with reduced corticosteroids in UC management, better risk stratification is needed to help identify patients for more timely biologic treatment.

Identifying inequities in an urban Latin American population: a cross-sectional study in Australian primary health care

2020 ◽  
Vol 26 (2) ◽  
pp. 140
Author(s):  
Luis Sanchez ◽  
Tracey Johnson ◽  
Suzanne Williams ◽  
Geoffrey Spurling ◽  
Joanne Durham
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Chronic Disease ◽  
Latin American ◽  
Linguistically Diverse ◽  
Cross Sectional Study ◽  
Culturally And Linguistically Diverse ◽  
Ageing Population ◽  
Sectional Study ◽  
Cross Sectional

In Australia, people from culturally and linguistically diverse backgrounds often face inequitable health outcomes and access to health care. An important, but under-researched, population is people of Latin American descent. A cross-sectional study obtained clinical data on Latin American Spanish-speaking patients from Brisbane’s south-west. Extracted data included demographic characteristics, risk factors, chronic disease and service use. A total of 382 people (60.5% female, 39.5% male), mainly from El Salvador and Chile and predominantly older people (70% over 50 years), were identified. Compared with the general Australian population, the proportion of people with dyslipidaemia, diabetes, arthritis and musculoskeletal, mental health disorders and being obese or overweight was high. There was also a higher use of the 20–40min general medicine consultation than in the general population. The proportion of patients receiving health promotion and chronic disease management activities was higher than in other reports. However, there were gaps in the provision of these services. The study shows an ageing population group with significant risk factors and an important burden of chronic disease and comorbidity. Addressing inequalities in health for culturally and linguistically diverse populations demands improvements in healthcare delivery and targeted actions based on a solid understanding of their complex health needs and their health, social and cultural circumstances.

Chronic Disease Prevention: Tobacco, Physical Activity, and Nutrition for a Healthy Start: A Vital Direction for Health and Health Care

2016 ◽  
Vol 6 (9) ◽  
Author(s):  
William H. Dietz ◽  
◽  
Ross C. Brownson ◽  
Clifford E. Douglas ◽  
John J. Dreyzehner ◽  
...  
Keyword(s):  
Physical Activity ◽  
Health Care ◽  
Chronic Disease ◽  
Disease Prevention ◽  
Healthy Start ◽  
Chronic Disease Prevention

Preliminary Anti-Coxsackie Activity of Novel 1-[4-(5,6-dimethyl(H)- 1H(2H)-benzotriazol-1(2)-yl)phenyl]-3-alkyl(aryl)ureas

2020 ◽  
Vol 16 (5) ◽  
pp. 677-688 ◽  
Author(s):  
Sandra Piras ◽  
Paola Corona ◽  
Roberta Ibba ◽  
Federico Riu ◽  
Gabriele Murineddu ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Antiviral Activity ◽  
Wide Spectrum ◽  
Immunocompromised Patients ◽  
Human Pathogen ◽  
Alkyl Aryl ◽  
Dna Viruses ◽  
Coxsackievirus B ◽  
Selective Activity

Background: Coxsackievirus infections are associated with cases of aseptic meningitis, encephalitis, myocarditis, and some chronic disease. Methods: A series of benzo[d][1,2,3]triazol-1(2)-yl derivatives (here named benzotriazol-1(2)-yl) (4a-i, 5a-h, 6a-e, g, i, j and 7a-f, h-j) were designed, synthesized and in vitro evaluated for cytotoxicity and antiviral activity against two important human enteroviruses (HEVs) members of the Picornaviridae family [Coxsackievirus B 5 (CVB-5) and Poliovirus 1 (Sb-1)]. Results: Compounds 4c (CC50 >100 μM; EC50 = 9 μM), 5g (CC50 >100 μM; EC50 = 8 μM), and 6a (CC50 >100 μM; EC50 = 10 μM) were found active against CVB-5. With the aim of evaluating the selectivity of action of this class of compounds, a wide spectrum of RNA (positive- and negativesense), double-stranded (dsRNA) or DNA viruses were also assayed. For none of them, significant antiviral activity was determined. Conclusion: These results point towards a selective activity against CVB-5, an important human pathogen that causes both acute and chronic diseases in infants, young children, and immunocompromised patients.

Are Communities Willing to Transition Into Learning Health Care Communities? A Community-Based Participatory Evaluation of Stakeholders’ Receptivity

2021 ◽  
pp. 104973232199864
Author(s):  
Nabil Natafgi ◽  
Olayinka Ladeji ◽  
Yoon Duk Hong ◽  
Jacqueline Caldwell ◽  
C. Daniel Mullins
Keyword(s):  
Health Care ◽  
Health Care Delivery ◽  
Health Care Professionals ◽  
Care Delivery ◽  
Lessons Learned ◽  
Community Members ◽  
Community Based ◽  
Care Community ◽  
Care Experience ◽  
National Initiative

This article aims to determine receptivity for advancing the Learning Healthcare System (LHS) model to a novel evidence-based health care delivery framework—Learning Health Care Community (LHCC)—in Baltimore, as a model for a national initiative. Using community-based participatory, qualitative approach, we conducted 16 in-depth interviews and 15 focus groups with 94 participants. Two independent coders thematically analyzed the transcripts. Participants included community members (38%), health care professionals (29%), patients (26%), and other stakeholders (7%). The majority considered LHCC to be a viable model for improving the health care experience, outlining certain parameters for success such as the inclusion of home visits, presentation of research evidence, and incorporation of social determinants and patients’ input. Lessons learned and challenges discussed by participants can help health systems and communities explore the LHCC aspiration to align health care delivery with an engaged, empowered, and informed community.

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