scholarly journals Reasons for Nonattendance across the Hepatitis C Disease Course

ISRN Nursing ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Gail Butt ◽  
Liza McGuinness ◽  
Terri Buller-Taylor ◽  
Sandi Mitchell
Keyword(s):  
Hepatitis C ◽  
Disease Course ◽  
Care Providers ◽  
Multiple Perspectives ◽  
Missed Opportunities ◽  
Social Service Delivery ◽  
Health And Social Care ◽  
Competing Priorities ◽  
Self Protection ◽  
Delivery Models

This descriptive qualitative study examined the patient, provider, and institutional factors contributing to nonattendance for hepatitis C (HCV) care throughout the disease course. Eighty-four patients and health and social care providers were interviewed. Thematic analysis of the data yielded 6 interrelated nonattendance themes: self-protection, determining the benefits, competing priorities, knowledge gaps, access to services, and restrictive policies. Factors within the themes varied with the disease course, type of provider/service, and patient context. Nonattendance could span months to years and most frequently began at diagnosis where providers either advised that followup was not necessary or did not recommend any followup. The way services were organized (low barrier access) and delivered (nonjudgmental approach) and higher HCV knowledge levels of patients and providers encouraged attendance. This is the first study to explore the reasons for nonattendance for HCV care throughout the disease course and validate them from multiple perspectives. There are missed opportunities for providers to encourage attendance throughout the disease course beginning at diagnosis. Interventions required include development of integrated health and social service delivery models; mechanisms to improve knowledge dissemination of the disease, its management, and treatment; and implementation of standardized followup protocols for liver disease monitoring in primary care.

scholarly journals Using concept mapping to prioritize barriers to diabetes care and self-management for those who experience homelessness

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Eshleen K. Grewal ◽  
Rachel B. Campbell ◽  
Gillian L. Booth ◽  
Kerry A. McBrien ◽  
Stephen W. Hwang ◽  
...  
Keyword(s):  
Mental Health ◽  
Concept Mapping ◽  
Diabetes Management ◽  
Healthy Food ◽  
Self Management ◽  
Chronic Medical Condition ◽  
Care Providers ◽  
Chronic Hyperglycemia ◽  
Health And Social Care ◽  
Competing Priorities

Abstract Background Diabetes is a chronic medical condition which demands that patients engage in self-management to achieve optimal glycemic control and avoid severe complications. Individuals who have diabetes and are experiencing homelessness are more likely to have chronic hyperglycemia and adverse outcomes. Our objective was to collaborate with individuals experiencing homelessness and care providers to understand the barriers they face in managing diabetes, as a first step in identifying solutions for enhancing diabetes management in this population. Methods We recruited individuals with lived experience of homelessness and diabetes (i.e. clients; n = 32) from Toronto and health and social care providers working in the areas of diabetes and/or homelessness (i.e. providers; n = 96) from across Canada. We used concept mapping, a participatory research method, to engage participants in brainstorming barriers to diabetes management, which were subsequently categorized into clusters, using the Concept Systems Global MAX software, and rated based on their perceived impact on diabetes management. The ratings were standardized for each participant group, and the average cluster ratings for the clients and providers were compared using t-tests. Results The brainstorming identified 43 unique barriers to diabetes management. The clients’ map featured 9 clusters of barriers: Challenges to getting healthy food, Inadequate income, Navigating services, Not having a place of your own, Relationships with professionals, Diabetes education, Emotional wellbeing, Competing priorities, and Weather-related issues. The providers’ map had 7 clusters: Access to healthy food, Dietary choices in the context of homelessness, Limited finances, Lack of stable, private housing, Navigating the health and social sectors, Emotional distress and competing priorities, and Mental health and addictions. The highest-rated clusters were Challenges to getting healthy food (clients) and Mental health and addictions (providers). Challenges to getting healthy food was rated significantly higher by clients (p = 0.01) and Competing priorities was rated significantly higher by providers (p = 0.03). Conclusions Experiencing homelessness poses numerous barriers to managing diabetes, the greatest of which according to clients, is challenges to getting healthy food. This study showed that the way clients and providers perceive these barriers differs considerably, which highlights the importance of including clients’ insights when assessing needs and designing effective solutions.

scholarly journals Using concept mapping to prioritize barriers to diabetes care and self-management for those who experience homelessness

2021 ◽  
Author(s):  
Eshleen K Grewal ◽  
Rachel B Campbell ◽  
Gillian L Booth ◽  
Kerry A McBrien ◽  
Stephen W Hwang ◽  
...  
Keyword(s):  
Mental Health ◽  
Glycemic Control ◽  
Concept Mapping ◽  
Diabetes Management ◽  
Healthy Food ◽  
Self Management ◽  
Chronic Medical Condition ◽  
Care Providers ◽  
Health And Social Care ◽  
Competing Priorities

Abstract Background Diabetes is a chronic medical condition which demands that patients engage in self-management to achieve optimal glycemic control and avoid severe complications. Individuals who have diabetes and are experiencing homelessness are more likely to have poor glycemic control and adverse outcomes. Our objective was to collaborate with individuals living with homelessness to better understand the barriers they face in managing diabetes, as a first step in identifying solutions for enhancing diabetes management in this population. Methods We recruited individuals with lived experience of homelessness and diabetes (i.e. clients; n = 32) from Toronto and health and social care providers working in the areas of diabetes and/or homelessness (n = 27) from across Canada. We used concept mapping, a participatory research method, to engage participants in brainstorming barriers to diabetes management, which were subsequently categorized into clusters and rated based on their impact on diabetes management. The ratings were also standardized for each participant group, organized according to the clients’ cluster structure, and those clusters were compared using t-tests. The Concept Systems Global MAX software was utilized to generate cluster maps. Results The brainstorming identified 43 barriers to diabetes management. The clients’ map featured 9 clusters of barriers: Challenges to getting healthy food, Inadequate income, Navigating services, Not having a place of your own, Relationships with professionals, Diabetes education, Emotional wellbeing, Competing priorities, and Weather-related issues. The providers’ map had 7 clusters: Access to healthy food, Dietary choices in the context of homelessness, Limited finances, Lack of stable, private housing, Navigating the health and social sectors, Emotional distress and competing priorities, and Mental health and addictions. The highest rated clusters were Challenges to getting healthy food (clients) and Mental health and addictions (providers). After standardizing, Challenges to getting healthy food was rated higher by the clients (p = 0.01) and Competing priorities (p = 0.03) was rated higher by the providers. Conclusions Experiencing homelessness poses numerous barriers to managing diabetes, the greatest of which according to clients, is Challenges to getting healthy food. This study showed that the way clients and providers perceive these barriers differs considerably, which highlights the importance of including clients’ insights when assessing needs and designing effective solutions.

scholarly journals Caregiver-Centered Care Health Workforce Competencies: Developing Consistent Support for Family Caregivers

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 15-15
Author(s):  
Jasneet Parmar ◽  
Sharon Anderson ◽  
Lisa Poole ◽  
Wendy Duggleby ◽  
Jayna Holyroyd-Leduc ◽  
...  
Keyword(s):  
Health System ◽  
Family Caregivers ◽  
Health Providers ◽  
Care Providers ◽  
Modified Delphi ◽  
Healthcare Settings ◽  
Delphi Approach ◽  
People With Dementia ◽  
Health And Social Care ◽  
Centered Care

Abstract Family caregivers [FCGs] are the backbone of the health system. They provide over 80% of the care for people with dementia, chronic illnesses and impairments. Despite evidence of their contributions and consequences of caregiving, support for FCGs has not been a health system priority. Education to prepare health providers to effectively identify, engage, assess, and support FCGs throughout the care trajectory is an innovative approach in addressing inconsistent system of supports for FCGs. We report on development and validation of the Caregiver-Centered Care Competency Framework to help with curricular design and subsequent evaluation of effectiveness of care providers working within healthcare settings to engage and support FCGs. We used a three round modified Delphi approach. An expert panel of 42 international, national, and provincial stakeholders agreed to participate. In the first 2 rounds, multi-level, interdisciplinary participants, rated the indicators in terms of importance and relevance. In the 3rd round consensus meeting, participants validated the six competency domains, including indicators in small group sessions. Thirty-four experts (81%) participated in the round 1, 36 (85.7%) in round 2, and 42 people (100%) in round 3. There was stable consensus across all three rounds, 96.07% of participants rated the indicators as essential or important (Round 1, 95.81%; Round 2, 94.15; Round 3, 98.23%). FCG research has been primarily focussed on educating FCGs to provide care. These competencies will shape the design of educational curricula and interdisciplinary training programs aimed at supporting the health and social care workforce to provide caregiver-centered care.

Learning from the report of the independent medicines and medical devices safety review: “first do no harm”

2022 ◽  
pp. 003693302110584
Author(s):  
Priyanka H Krishnaswamy ◽  
Marie-Anne Ledingham ◽  
Veenu Tyagi ◽  
Karen Lesley Guerrero
Keyword(s):  
Healthcare System ◽  
Medical Devices ◽  
Current Response ◽  
Missed Opportunities ◽  
Safety Review ◽  
Anti Epileptic Drug ◽  
Do No Harm ◽  
Clinical Scenarios ◽  
Health And Social Care ◽  
Learning Points

This is a review of the learning points from the Independent Medicines and Medical Devices Safety Review, 1 chaired by Baroness Julia Cumberlege CBE DL. This system-wide review was initiated by the then Secretary of State for Health and Social Care, following patient-led campaigns. It looked at how the “healthcare system reacted as a whole, and how that response can be made more robust, speedy and appropriate”. We aim to highlight the learning points for doctors in Obstetrics and Gynaecology as these are relevant to our current practice and future changes in our healthcare system. These are: Aims of the review: why it was initiated and how it was conducted Overarching themes and missed opportunities to prevent avoidable harm Three clinical scenarios: their histories, issues and adverse events associated with their use and the current response in Scotland The hormone pregnancy test - Primodos The anti-epileptic drug - sodium valproate Surgical mesh for prolapse & incontinence The recommendations made by the review and implementation guidance Responses to the review, such as apologies issued by BSUG 2 /BAUS 3 /RCOG, 4 and compensations schemes such as the Scottish scheme as recommended by the review

The Partners HealthCare Settlement and the Future of Health Care Organizations

2014 ◽  
Vol 11 (1) ◽  
Keyword(s):  
Health Care ◽  
Market Power ◽  
Health Care Providers ◽  
Federal Trade Commission ◽  
Health Care Organizations ◽  
Care Delivery ◽  
Health Sector ◽  
Care Providers ◽  
Unique Challenge ◽  
Delivery Models

AbstractA recent settlement between Massachusetts and Partners HealthCare, along with successful antitrust actions by the Federal Trade Commission, may signal the beginning of the end of two decades of consolidation of health care providers. This consolidation has been associated with higher prices resulting from market power, justifying the antitrust actions. However, the appropriate remedy for the health sector is a unique challenge. The proposed settlement appears to lock into place the legacy of the hospital-based delivery model, rather than orchestrating a pathway to a new care delivery models. Clearly, we need a regulatory framework that will introduce innovative alternatives into the market, not enshrine the current costly paradigm.

scholarly journals The barriers and facilitators to implementing dementia education and training in health and social care services: a mixed-methods study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Claire A. Surr ◽  
Sahdia Parveen ◽  
Sarah J. Smith ◽  
Michelle Drury ◽  
Cara Sass ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Behaviour Change ◽  
Social Care ◽  
Education And Training ◽  
Barriers And Facilitators ◽  
Care Providers ◽  
Care Services ◽  
Health And Social Care ◽  
And Training ◽  
Dementia Education

Abstract Background The health and social care workforce requires access to appropriate education and training to provide quality care for people with dementia. Success of a training programme depends on staff ability to put their learning into practice through behaviour change. This study aimed to investigate the barriers and facilitators to implementation of dementia education and training in health and social care services using the Theoretical Domains Framework (TDF) and COM-B model of behaviour change. Methods A mixed-methods design. Participants were dementia training leads, training facilitators, managers and staff who had attended training who worked in UK care homes, acute hospitals, mental health services and primary care settings. Methods were an online audit of care and training providers, online survey of trained staff and individual/group interviews with organisational training leads, training facilitators, staff who had attended dementia training and managers. Data were analysed using descriptive statistics and thematic template analysis. Results Barriers and facilitators were analysed according the COM-B domains. “Capability” factors were not perceived as a significant barrier to training implementation. Factors which supported staff capability included the use of interactive face-to-face training, and training that was relevant to their role. Factors that increased staff “motivation” included skilled facilitation of training, trainees’ desire to learn and the provision of incentives (e.g. attendance during paid working hours, badges/certifications). “Opportunity” factors were most prevalent with lack of resources (time, financial, staffing and environmental) being the biggest perceived barrier to training implementation. The presence or not of external support from families and internal factors such as the organisational culture and its supportiveness of good dementia care and training implementation were also influential. Conclusions A wide range of factors may present as barriers to or facilitators of dementia training implementation and behaviour change for staff. These should be considered by health and social care providers in the context of dementia training design and delivery in order to maximise potential for implementation.

scholarly journals P52 A baseline review of the activity of the PICU pharmacists using electronically captured data

2020 ◽  
Vol 105 (9) ◽  
pp. e34.1-e34
Author(s):  
Diarmaid Semple ◽  
Erika Brereton ◽  
Ian Dawkins
Keyword(s):  
Information Quality ◽  
Good Practice ◽  
Clinical Information ◽  
Information Management System ◽  
List Type ◽  
Care Providers ◽  
Medication Error Reporting ◽  
Medicines Reconciliation ◽  
Health And Social Care ◽  
American Medical Informatics Association

AimTo date there are no metrics for the clinical pharmacist service to PICU. It is accepted that use of a Clinical Information Management System (CIMS) has a role in medication safety,1 however there are few studies that review the information potential of a CIMS for collecting pharmacist activity.2MethodAdditional fields and custom reports were configured in the CIMS to enable PICU pharmacists to record their activity in the following areas:Medicines reconciliation within 72 hours of admission to PICUDischarge kardex reviewAnalgesia and sedation (A&S) reviewClinical pharmacy reviewOther interventions & medication error reporting continued as per normal practice. Data was analysed using Microsoft Excel®.ResultsComplete data was available from July 2017 to end of 2018.There were 1274 medicines reconciliations by a pharmacist within 72 hours of admission (78% admissions). 14% of discharge kardexes had been reviewed prior to discharge to the ward. There was an average of 190 pharmacy reviews per 100 bed days. A total of 780 Pharmacist A&S Plans were documented by the clinical pharmacists – an average of 2 per working day, and 48% of admissions.Comparisons between each six month period showed a significant increase in the number of pharmacists medicines reconciliations (p<0.001). No other differences were found.ConclusionThis study has shown that electronic tracking of pharmacist ward activity is possible. It has the potential to demonstrate compliance with external or internal standards and audits. This data continues to be collected, and therefore these results will be used as a baseline to compare future activity. The findings of this study may encourage other units to replicate, providing data that can be used for comparison. Further configuration of the CIMS to capture other metrics such as TDM, and document discrepancies in medicines reconciliation is planned.ReferencesForni A, Chu H, Fanikos J. Technology Utilization to Prevent Medication Errors. Current Drug Safety. 2010;5:13–18.Nelson S, Poikonen J, Reese T, El Halta D, Weir C. The pharmacist and the EHR. Journal of the American Medical Informatics Association. 2016;24:193–197.Health and Information Quality Authority. Guidance for health and social care providers; Principles of good practice in medication reconciliation. Dublin: HIQA; 2014

scholarly journals Addressing embodied inequities in health: how do we enable improvement in women’s diet in pregnancy?

2020 ◽  
Vol 23 (16) ◽  
pp. 2994-3004
Author(s):  
L McKerracher ◽  
S Oresnik ◽  
T Moffat ◽  
B Murray-Davis ◽  
J Vickers-Manzin ◽  
...  
Keyword(s):  
Intervention Development ◽  
Embodied Experience ◽  
Care Providers ◽  
Network Analyses ◽  
Health And Social Care ◽  
Conceptual Maps ◽  
Canadian City ◽  
Multiple Levels ◽  
Relational Resources ◽  
Support Programmes

AbstractObjective:To disrupt cycles of health inequity, traceable to dietary inequities in the earliest stages of life, public health interventions should target improving nutritional wellbeing in preconception/pregnancy environments. This requires a deep engagement with pregnant/postpartum people (PPP) and their communities (including their health and social care providers, HSCP). We sought to understand the factors that influence diet during pregnancy from the perspectives of PPP and HSCP, and to outline intervention priorities.Design:We carried out thematic network analyses of transcripts from ten focus group discussions (FGD) and one stakeholder engagement meeting with PPP and HSCP in a Canadian city. Identified themes were developed into conceptual maps, highlighting local priorities for pregnancy nutrition and intervention development.Setting:FGD and the stakeholder meeting were run in predominantly lower socioeconomic position (SEP) neighbourhoods in the sociodemographically diverse city of Hamilton, Canada.Participants:All local, comprising twenty-two lower SEP PPP and forty-three HSCP.Results:Salient themes were resilience, resources, relationships and the embodied experience of pregnancy. Both PPP and HSCP underscored that socioeconomic-political forces operating at multiple levels largely determined the availability of individual and relational resources constraining diet during pregnancy. Intervention proposals focused on cultivating individual and community resilience to improve early-life nutritional environments. Participants called for better-integrated services, greater income supports and strengthened support programmes.Conclusions:Hamilton stakeholders foregrounded social determinants of inequity as main factors influencing pregnancy diet. They further indicated a need to develop interventions that build resilience and redistribute resources at multiple levels, from the household to the state.

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