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Jacobson, Eva. "Pain management in outpatient knee arthroscopy /". Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-642-5/.
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Anyiam, Helen. "Educating Staff Members in an Outpatient Clinic on Hypertension Management". Thesis, Walden University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10930842.
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An educational module on hypertension was created in response to the recurring pattern of patient visits with hypertension and an observed knowledge gap among nursing staff in an outpatient clinic located in the southern United States. The educational module was patterned after Joint National Committee-8 and American College of Cardiology guidelines involving patient lifestyle modification and provided clinic staff with information on hypertension diagnosis and self-management for use in patient education. The module was reviewed by a panel of 3 experts who approved it for appropriateness and clarity of content and made one minor recommendation for revision. The education materials were modified to meet the panel’s recommendations and subsequently presented to 5 nursing staff members. Pre- and postmodule questionnaires were provided to the staff to determine the extent of their learning from the education program. Pretest results indicated that staff lacked information on the guidelines for treatment of hypertension. Posttest results indicated that all 5 participants found the module information useful for staff to use in educating patients on self-management of hypertension. Providing nursing staff with current evidence-based practice guidelines can increase staff nurse knowledge on hypertension management. Educating nursing staff has the potential to effect positive social change by empowering staff and patients to improve health care outcomes by enabling staff to coach patients on hypertension management using up-to-date evidence-based practice guidelines.
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White, Denise L. "Operational Planning and Scheduling in the Outpatient Clinic Environment". University of Cincinnati / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1276527552.
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Okonofua, Modupe Mary. "Depression Management in Outpatient Settings: A Systematic Review of the Literature". ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5392.
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Depression is a mental illness that requires prompt identification and treatment due to grave consequences if untreated. Depression can affect a person's level of functioning, lead to worsening health conditions, comorbid substance abuse, and suicide. Despite these facts, the current state of nursing practice includes an inadequate diagnosis of patients with depression, lack of guidelines for the use of assessment tools and diagnostic tests to identify depression, and insufficient information concerning the accuracy of depression assessment tools. This systematic literature review examined 6 depression assessment tools in regard to their accuracy as identified by specificity, sensitivity, reliability, and validity. This project also examined the pros and cons, demographics, and healthcare settings that use these depression inventory tools. This project used the Orlando nursing process theory as a theoretical framework. Based on the review of 10 articles selected, evidence showed that the Hamilton depression rating scale has the highest sensitivity (93%) and specificity (97%) rates. The implications for positive social change include the opportunity for clinicians to use the findings of this project in their selection of depression assessment tools in healthcare settings. Other researchers can use this project as a valuable resource for management of major depressive disorders.
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Leung, Tai-tei Betty y 梁帶娣. "Evidence-based guideline on nanocrystalline silver (ACTICOAT) therapy for outpatient burn management". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B4658268X.
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Cruze, Erin Michelle. "An Exploratory Study of Toxicology Screening Policies in Outpatient Pain Clinics". The Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1338232409.
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Marshall, Adam Ryan. "Improving outpatient non-oncology infusion through centralization and scheduling heuristics". Thesis, Massachusetts Institute of Technology, 2016. http://hdl.handle.net/1721.1/104307.
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Thesis: M.B.A., Massachusetts Institute of Technology, Sloan School of Management, 2016. In conjunction with the Leaders for Global Operations Program at MIT.Thesis: S.M. in Engineering Systems, Massachusetts Institute of Technology, Department of Mechanical Engineering, 2016. In conjunction with the Leaders for Global Operations Program at MIT.
Cataloged from PDF version of thesis.
Includes bibliographical references (pages 117-119).
The use of highly effective intravenously infused specialty drugs has increased significantly over the past two decades as they have led to dramatic improvements in patients' quality-of- life. At Massachusetts General Hospital, these drugs are administered in ten independent outpatient clinics. While some clinics only need to offer sporadic treatments and have low utilization of resources, other clinics find patient access is severely limited due to high utilization, poor scheduling practices, and inadequate staffing. This thesis describes methods to increase patient access to infusion while improving resource utilization. Underlying this improvement is a specially developed scheduling algorithm that smooths chair utilization while permitting flexible, multi-day scheduling. By employing the new scheduling algorithm, the recommended centralized infusion unit will be able to provide more expedient care, offer emergent appointments, avoid unnecessary hospital infusion admissions, and make more efficient use of clinical resources. Adding only two days of flexibility to appointments reduces resource requirements by up to 57%. Also, the day-to-day variability in patient volume is stabilized. Finally, the centralization of administrative resources ensures efficient prior authorization processing, leading to significant financial savings.
by Adam Ryan Marshall.
M.B.A.
S.M. in Engineering Systems
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Zurovac, Dejan. "Malaria outpatient management in government health facilities in Kenya : an evaluation of current practices". Thesis, Open University, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.422003.
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Nguyen, Lisa L. "Pacific Psychiatric Group| A Business Plan For a Direct Pay Outpatient Psychiatric Practice". Thesis, California State University, Long Beach, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10604226.
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The demand for psychiatry is driven by the amount of patients that require mental health services. In the United States, there is a growing need for mental health services. One in every 5 adults in America suffers from some type of mental illness; 1 in every 20 has a serious mental illness. In 2014, 60% of adults living with a mental illness did not receive treatment for it. The amendment of the Mental Health Parity and Addiction Equity Act by the Patient Protection and Affordable Care Act has expanded access to mental health services. However, although the accessibility to psychiatric services has increased, a shortage of psychiatrists has resulted in long wait times, creating challenges to meet the demand. Pacific Psychiatric Group is a direct pay, outpatient practice that offers mental health services at competitive, fixed cash rates. Insurance will not be accepted. The burden of overhead dealing with the bureaucracy and administration of insurance will be eliminated, which helps to keep costs low and allows providers to focus on the patient. Pacific Psychiatric Group’s mission is to alleviate accessibility challenges and provide timely, high quality, personalized, patient-focused mental health services. This proposed business plan will demonstrate how Pacific Psychiatric Group plans to improve accessibility, transparency, and quality of psychiatric services in an effort to reduce the number of untreated individuals.
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Phillips, Martha A. "Improving the Transition of Care for Psychiatric Patients Moving from Inpatient to Outpatient Psychiatric Healthcare Settings". Thesis, University of Louisiana at Lafayette, 2019. http://pqdtopen.proquest.com/#viewpdf?dispub=10815412.
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Abstract The aim of this quality improvement (QI) project was to explore whether the implementation of an enhanced telephone reminder system improved the rate of attendance at initial follow-up appointment and medication adherence. A total of 86 patients, discharged from inpatient psychiatric units with a follow-up within 7 days of discharge, were eligible to receive the enhanced telephone contact reminder and follow-up text. A preliminary retrospective chart review was conducted to collect historical data on medication and attendance adherence. A prospective interventional design was used to implement the QI project. Patients received telephone contact within 24-72 hours of discharge and text message reminder strategies. A medication adherence assessment was completed at telephone contact and at initial follow-up appointment. An analysis of the data examined the impact of the TCM strategy on patient?s rate of adherence to medication and initial follow-up appointments. Descriptive analysis assessed the frequency of medication adherence in retrospective and implementation data. Inferential statistics analyzed factors of association such as prior clinic services and rate of attendance at follow-up appointment. In the retrospective chart review (n=57), data revealed a 28% attendance rate and an 81% medication adherence at the follow-up appointment, with no statistical difference in a 145 history of prior series on attendance. Implementation data on medication adherence at telephone contact and at first follow-up appointment revealed a 61.5% medication adherence rate at telephone contact and 80% adherence rate at first follow-up appointment. The predictor value of a prior history of service on attendance at first follow-up appointment revealed no statistically significant difference. The project, however, resulted in clinically significant benefits that promoted individual patients? medication-taking behaviors and decisions to attend follow-up appointments, and improved clinical practices at the BHC.
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Saunders, Simon. "Challenges in the management of younger adults with type 1 diabetes in hospital outpatient and inpatient settings". Thesis, University of Liverpool, 2009. http://livrepository.liverpool.ac.uk/1347/.
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This thesis examines the challenges of managing a population of patients with type 1 diabetes who initially attended a hospital outpatient clinic between 1991 and 1996. These 386 patients are subsequently reviewed in 2001 and 2006. The continued attendance at the clinic, level of glycaemic control and prevalence of microvascular and macrovascular complications are assessed. In demonstrating the outcomes of this cohort of patients they are compared to the patients within the landmark study The Diabetes Control and Complications Trial (DCCT). The DCCT showed conclusively that good glycaemic control decreased the risk of developing microvascular complications when compared to those patients with less tight glycaemic control. The findings of this study definitively demonstrated the benefits of good glycaemic control. What was also apparent, but a less publicised finding of this trial was the increase in episodes of hypoglycaemia and the weight gain seen in the group with intensive control arm. How do patients in the ‘real-world’ compare to those patients within the DCCT study, is such good control achievable outside the setting of a clinical trial? The outcomes of the patients attending the younger adult diabetes clinic are demonstrated to be similar to those patients in the DCCT who were controlled conventionally, despite encouragement to adopt an intensive insulin regime and offered regular clinical review from both diabetes specialist nurses and consultant. The potential causes for the differences in glycaemic control between an outpatient clinic and those patients in the DCCT are explored. The thesis also examines the difficulties in managing the small numbers of patients with type 1 diabetes who are hospital inpatients. In particular, a group of patients with diabetes who are also intravenous drug abusers are studied. This group are compared to other inpatients and the study clearly shows episodes of frequent admissions and very high mortality rates in the study group. In conclusion the thesis highlights the many problems which exist when trying to manage type 1 diabetes in the outpatient setting including clinic non-attendance, prevalence of other medical problems and limiting factors such as weight gain and hypoglycaemia. Discussion is also made of ways in which to address these issues and improve control for this group of patients.
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Tadesse, Elazar. "Integrated community-based management of severe acute child malnutrition : Studies from rural Southern Ethiopia". Doctoral thesis, Uppsala universitet, Internationell mödra- och barnhälsovård (IMCH), 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-292781.
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Background: The World Health Organization (WHO) recommends the community-based Outpatient Therapeutic Program (OTP) as a standard treatment protocol for the management of uncomplicated Severe Acute Malnutrition (SAM) at the community level. OTP has been scaled up and integrated into the existing grassroots level government health systems in several developing countries. The aim of this thesis was to assess the implementation and outcome of a scaled-up and integrated OTP service provided at community level. Methods: One qualitative study and three quantitative studies were conducted in southern Ethiopia. Children admitted to 94 integrated OTPs, their caregivers and health extension workers providing primary health care services in the nearby health posts were included in this study. The quantitative studies were based on data generated from observation of a cohort of 1,048 children admitted to the integrated OTPs. Result: On admission 78.8% of the children had SAM. The majority of these children 60.2% exited the program neither achieving program recovery criteria nor being transferred to inpatient care. Fourteen weeks after admission to OTP, 34.6% were severely malnourished and 34.4% were moderately malnourished, thus 69.0% were still acutely malnourished. Ready-to-use Therapeutic Foods (RUTFs) provided for SAM children were commonly shared with other children in the household and sold as a commodity for the collective benefit of the family thus admitted children received only a portion of the provided amount. Further, the program suffered a severe shortage of RUTFs, where only 46.6% of admitted children were given the recommended amount of RUTFs by providers on admission and only 34.9% of these had uninterrupted provision during the follow-up. Conclusion: The integrated OTPs we studied provide a constrained service and the use of RUTFs by families is not as intended by the program. The majority of admitted children remained acutely malnourished after participating in the program for the recommended duration. For integrated OTPs to be effective in chronically food-insecure contexts, interventions that also address the economic and food needs of the entire household are essential. This may require a shift to view SAM as a symptom of broader problems affecting a family rather than as a disease of an individual child. In addition, further research is needed to understand the health system context regarding RUTFs and medication supply and service utilization of integrated OTPs.
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Chrest, K. Tyler. "Employee Motivation Related to Leadership Behaviors in Rural Outpatient Healthcare Settings". Franklin University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=frank1608581990857996.
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Hur, Inkyoung. "Patient-centered care process enabled by Integrative Social Media Platform in an outpatient setting". FIU Digital Commons, 2016. http://digitalcommons.fiu.edu/etd/3057.
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As an effort to guide patients toward being more informed and more involved as healthcare decision makers in the clinical processes, health care organizations have adopted a new technology referred to as an integrative social media platform (ISMP). This ISMP combines features of mobile technology and those of social media technology, integrating healthcare systems in order to support a more patient-centered healthcare process. However, users, both physicians and patients, have showed varied usages of ISMP, as a results, have shown mixed results of ISMP. To provide a better understanding of the use of ISMP, especially the interaction between patients and physicians, I turned to the concept of affordances. Affordances describe the possibilities for goal-oriented actions that a technical object offers to a user. Using a mixed-method approach with real archival event log data, conversation texts, documents, interview, and focus-group data from a large hospital which had adopted an ISMP, I confirmed three types of affordance: perceived affordance, behavioral affordance, and interactive affordance. I identified two key affordances of ISMP that lead to patient-centered care, namely ubiquitous access and virtual healthcare consultation, which represent a behavioral affordance and an interactive affordance, respectively. I also explored how different types of affordances are actualized and how they interact with each other to contribute to patient-centered care.
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Mwanza, Mike. "Evaluation of the outpatient therapeutic programme for management of severe acute malnutrition in three districts of eastern province , Zambia". University of Western Cape, 2013. http://hdl.handle.net/11394/3919.
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Magister Public Health - MPHThe Outpatient Therapeutic Programme (OTP) is an integrated public health innovation for treating severe acute malnutrition without medical complications in children 6 to 59 months of age as outpatients within their communities using Ready to Use Therapeutic Food with the aim of reducing case fatality rates. The OTP approach is implemented in the three districts in Eastern Province of Zambia namely; Chipata, Katete and Petauke. Since inception of the OTP in the province, an evaluation of the OTP has not been conducted. The study is aimed at assessing the effectiveness of the implementation of the OTP for management of severe acute malnutrition in the three districts of Eastern Province of Zambia.
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Zoll, Brian M. "Evaluating the E-consult Process for Diabetes Care Delivery at an Outpatient Care Clinic". Wright State University / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=wright1369051267.
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McKay, Rachel Margaret. "In search of improved approaches to antibiotic stewardship : can we explain variations in physician practice patterns related to outpatient infection management?" Thesis, University of British Columbia, 2017. http://hdl.handle.net/2429/63396.
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The discovery of antibiotics was one of the most significant advances in modern medicine; however, our reliance on antibiotics is threatened by the spread of resistance. Antibiotic resistance is a natural phenomenon that is exacerbated by selection pressure from antibiotic use. Where prescriptions are required for antibiotics, understanding prescribing behaviour is paramount. Guidelines recommend antibiotics for respiratory tract infections (RTIs) only when pneumonia or other serious complications are suspected. Urine cultures are recommended for complicated, but not uncomplicated, urinary tract infections (UTIs). The objectives of this thesis were to identify factors related to patients, physicians, and geographic regions associated with antibiotic use for RTIs, and urine culturing for UTI; and to explore the extent of variations in these practices across physicians.
A systematic review of the literature was conducted to assess factors that have previously been empirically associated with antibiotic prescribing. Then, using linked administrative datasets, factors associated with antibiotic prescriptions for paediatric respiratory tract infection were analyzed. Urine culture data was subsequently linked in, to explore urine culturing practices.
These analyses demonstrated that observed physician characteristics had a stronger influence on practice patterns that did differences in patient characteristics. In particular, physicians who had been in practice for longer tended to be more likely to prescribe antibiotics, and to order urine cultures. Physicians trained outside of Canada were more likely to prescribe, but less likely to order a urine culture. Female physicians were less likely to prescribe antibiotics, and more likely to order urine cultures. The variation between physicians that remained after accounting for observed characteristics was substantial.
This research demonstrates some common features of physicians that are associated with antibiotic prescribing and urine culture use. However, the variation between physicians in practice styles is greater than the effects of these characteristics. These findings have implications for the design and implementation of antibiotic stewardship efforts to improve antibiotic use. For example, audit and feedback interventions and academic detailing have shown some promise, and may be particularly effective if targeted to physicians with higher prescribing or culturing practices. This thesis demonstrates the utility of administrative datasets in identifying such physicians.Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate
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Campbell, Teresa Isabelle 1959. "THE OUTPATIENT SERVICES DEPARTMENT AT TUCSON MEDICAL CENTER: AN EVALUATION FROM AN OPERATIONS MANAGEMENT PERSPECTIVE (MORNING ADMISSIONS, PRE-ADMISSION TESTING, ARIZONA)". Thesis, The University of Arizona, 1986. http://hdl.handle.net/10150/276343.
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Farmer, Cortney, Havya Dave, Zachary Sumpter, Patricia Conner y Amanda Stoltz. "OUTPATIENT EVALUATION & MANAGEMENT BILLING AND CODING: DEVELOPMENT OF ENDURING CURRICULUM FOR PGY1 RESIDENT EDUCATION IN A RURAL FAMILY MEDICINE PRACTICE". Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/asrf/2018/schedule/162.
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Accurate Evaluation and Management (E&M) billing and coding is an essential skill for medical clinicians. Consequences of incorrect E&M billing and coding include delayed patient treatment, delayed reimbursements from third party payers, and even charges of insurance fraud. The accuracy of billing and coding is especially salient in practices whose patient population is covered primarily by Medicare/Medicaid, as is the case in many Northeast Tennessee clinics. Despite the importance of accurate E&M billing and coding, recently graduated physicians moving into their first year of residency are often under-informed regarding proper billing and coding. Much of their knowledge about the process is picked up piecemeal over the course of their residency. The purpose of this study is to educate incoming post-graduate year one (PGY1) medical residents on the E&M billing and coding system for a rural Family Medicine clinic. During their first month as PGY1 resident physicians, participants were given a survey to assess their knowledge of E&M billing and coding for outpatient encounters. Participants then attended an educational session on this topic and received handouts that they could reference in the future. The participants were then surveyed again. Data analysis is currently underway. A repeated measure t-test will be utilized to determine if the educational session and informational handouts led to a statistically significant increase in PGY1 resident knowledge of E&M billing and coding. It is expected that participants will show significant knowledge gains as a result of the educational training. This research has important implications for medical resident training, particularly in rural practices that treat large populations covered by Medicare/Medicaid.
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Forren, Jan Odom. "POST DISCHARGE NAUSEA AND VOMITING IN AMBULATORY SURGICAL PATIENTS: INCIDENCE AND MANAGEMENT STRATEGIES". Lexington, Ky. : [University of Kentucky Libraries], 2009. http://hdl.handle.net/10225/1141.
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Thesis (Ph. D.)--University of Kentucky, 2009.Title from document title page (viewed on May 12, 2010). Document formatted into pages; contains: vii, 166 p. : ill. Includes abstract and vita. Includes bibliographical references (p. 141-157).
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Grodrian, Stanley Wayne. "High Reliability at a U.S. Air Force Outpatient Clinic: Have We Improved and are We Ready for the Future". Franklin University / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=frank1628018844639682.
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Krok, Jessica. "The Relationship between Self-Reported Cancer Pain and Personality in Black and White Older Adults receiving Outpatient Cancer Care". Scholar Commons, 2012. http://scholarcommons.usf.edu/etd/4109.
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It is well-established that personality not only affects physical health and longevity, but also mental health and coping mechanisms. One area of limited research is the relationship between cancer pain and personality. This study examined how personality traits affect reported cancer pain severity in older patients (N = 150) receiving outpatient treatment at a comprehensive cancer center. Participants were interviewed regarding their pain severity, personality, affect, and self-efficacy for pain management. Symptom data were collected from the Brief Pain Inventory, while personality data were gathered from the Ten Item Personality Inventory and the Positive and Negative Affect Schedule. Self-efficacy for pain management was collected from the Chronic Pain Self-efficacy Scale. Analyses included descriptives, Chi-square tests, t-tests, stepwise linear regressions, and moderation analyses. The mean age of the sample was 65.38 ± 7.72 years. Seventy-nine percent of the sample was White. Analyses indicated that the average pain was 4.15 ± 2.01 (0-10 scale; with 10 being worst pain), with the sample recording means of 6.53 ± 2.57 and 2.45 ± 2.15 on worst and least pain, respectively. Regression analyses showed extraversion (â = -0.21, p < .01) and openness to experience (â = 0.18, p < .05) to be significant predictors of higher current and average pain severity, respectively. Agreeableness (â = 0.18, p < .05) was found to be a significant predictor of higher self-efficacy for pain management. Conscientiousness and extraversion were significant moderators in the relationship between self-efficacy for pain management and worst pain severity. These findings indicate that different personality types and personal affect may influence reports of pain severity. More empirical research is needed to understand the impact of personality and its relationship with pain severity and self-efficacy for pain management in more diverse and marginalized cancer populations across the age continuum. Finally, the results may be used to design more individualized interventions on pain management, depending on personality type, an application that has never been done in older adults with cancer.
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Summers, Nancy J. "The effect of outpatient management of cancer patients after autologous blood stem cell transplantation on psychological, social and physical well-being and quality of life". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape17/PQDD_0023/MQ35000.pdf.
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Meisenhelder-Smith, Jodee. "The effects of American Diabetes Association (ADA) diabetes self-management education and continuous glucose monitoring on diabetes health beliefs, behaviors and metabolic control". [Tampa, Fla] : University of South Florida, 2006. http://purl.fcla.edu/usf/dc/et/SFE0001837.
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Elvås, Katarina. "Den specialistutbildade sjuksköterskans betydelse och roll i den psykiatriska öppenvården ur ledningsperspektiv". Thesis, Ersta Sköndal högskola, Institutionen för vårdvetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-5621.
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Bakgrund: Psykiatrisjuksköterskan har historiskt sett pendlat mellan att vara omvårdnadsansvarig till att vara förlängd arm till andra yrkeskategorier som till exempel läkare. Studier visar att specialistsjuksköterskan har en komplex kompetens som hen upplever inte alltid lyfts av organisationen och att hen ofta upplever sig klämd emellan patienters, medarbetares och organisationens krav. Specialistsjuksköterskor i psykiatrisk vård börjar nu bli en bristvara och då deras roll, status och betydelse framstår som diffus kan det bli svårt att rekrytera nya sjuksköterskor att utbilda sig och stanna kvar inom psykiatrisk vård. Då mycket få studier är genomförda i psykiatrisk öppenvård och med ledningsperspektiv var det av intresse att tillfråga just enhetschefer med ansvar att anställa personal. Syfte: Att beskriva enhetschefers uppfattningar om och förväntningar på specialistsjuksköterskans betydelse och roll i psykiatrisk öppenvården. Metod: Studien genomfördes som en empirisk intervjustudie med semistrukturerade frågor som ställdes individuellt till sju enhetschefer verksamma inom psykiatrisk öppenvård. Materialet bearbetades med en kvalitativ innehållsanalys med induktiv ansats. Resultat: I resultatet framkom huvudkategorin ”Arbetsuppgifter och förväntningar” med underkategorierna Bedömningar, Samordnande och samverkande roll, Läkemedelsadministrering, Utvecklingsarbete, Flexibla ansvarsområden, Bemötande och kommunikation samt Kompetens. Diskussion: Specialistsjuksköterskan har många olika roller att träda in i inom psykiatrisk öppenvård och förväntas använda sin kompetens där den behövs.Background: Psychiatric nurses has historically oscillated between being responsible of nursing care to be an extended arm to other professionals such as physicians. Studies show that the specialist nurse has a complex competence that according to the nurses is not always highlighted by the organization and often find themselves trapped between patients, other employees and the organization's demands. Specialist nurses in psychiatric care are now becoming scarce and when their role, status and importance appears diffuse, it may be difficult to recruit new nurses to train and remain in psychiatric services. Since very few studies have been carried out in outpatient psychiatric services and management perspective, it was of interest to the matter to ask the views of unit managers with responsibility to hire staff. Aim: To describe unit managers' perceptions and expectations of the specialist nurse's importance and role in psychiatric outpatient services. Method: The study was conducted as an empirical interview study with semi-structured questions that were asked individually to seven unit managers occupied in psychiatric outpatient care. The material was processed with a qualitative content analysis with inductive approach. Results: The result showed the main category "Duties and expectations" with the subcategories Assessments, Coordinating and cooperative role, Drug administration, Development, Flexible responsibilities, Treatment and communication as well as Competence. Discussions: The specialistnurse has many variable roles to enter in psychiatric outpatient care and are expected to use their expertise where it is needed.
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Abensur, Laure. "Dyskaliémie : fréquence, pronostic, prise en charge et iatrogénèse Hypokalemia is frequent and has prognostic implications in stable patients attending the emergency department Hyperkalaemia and hypokalaemia outpatient management: a survey of 500 French general practitioners Dyskalemia: a management problem for students". Thesis, Université de Lorraine, 2020. http://www.theses.fr/2020LORR0200.
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Contexte. Les troubles du potassium sont fréquents et associés à une augmentation de la mortalité toutes causes confondues, prenant la forme d’une courbe en U. Néanmoins, il existe peu de données sur les dyskaliémies en service d’urgence, en particulier chez des patients non critiques, alors qu’ils représentent une part importante de l’activité des services d’urgence. De plus, nous n’avons pas de données concernant les prises en charge des dyskaliémies par les médecins généralistes. Objectifs : Les objectifs étaient d’étudier les facteurs associés à une dyskaliémie chez des patients non critiques aux urgences, et, de connaître les pratiques des médecins généralistes et des internes de médecine générale face à la découverte d’une hyper ou d’une hypokaliémie (seuils connus, seuils de prise en charge et attitude face aux médicaments ayant une action sur la kaliémie). Méthodes. Pour le premier article, nous avons utilisé les données d’une étude observationnelle transversale multicentrique (onze centres d’urgences). Pour le second article, nous avons mené une enquête téléphonique auprès de 500 médecins généralistes répartis sur le territoire français. Pour le troisième article, nous avons interrogé 357 internes en médecine générale à l’aide d’auto-questionnaires. Résultats. Nous avons décrit les facteurs associés à la présence d’une dyskaliémie dans les services d’urgences chez des patients se présentant dans un état médical non critique. La dyskaliémie y est fréquente et l’hypokaliémie retrouvée chez près de 50 % des patients. Cette proportion est plus importante que celle décrite dans des populations comprenant l’ensemble des passages aux urgences, suggérant que l’hypokaliémie serait prépondérante chez des malades non critiques. L’hypokaliémie est dans cette population associée au sexe féminin et à l’usage des diurétiques thiazidiques. Elle est également associée à un pronostic plus défavorable. En ce qui concerne l’hyperkaliémie, elle était associée aux médicaments bloqueurs du système rénine angiotensine aldostérone et à l’insuffisance rénale chronique. Notre enquête auprès de 500 médecins généralistes du territoire français montre qu’il existe une grande hétérogénéité de la prise en charge des dyskaliémies par les médecins généralistes et que certaines pratiques ne sont pas optimales, par exemple le non contrôle biologique en cas d’hyperkaliémie ou encore l’arrêt définitif de médicaments ayant un effet de protection cardio-vasculo-rénale démontrée. Notre enquête auprès des internes a révélé une grande similitude de pratiques avec celle des médecins en exercice. En effet, que ce soit chez les médecins généralistes ou les internes, les seuils usuels de dyskaliémies sont connus et les divergences reflètent bien les différentes définitions retrouvées dans la littérature. Le résultat le plus saillant est le fait que l’hypokaliémie semble plus négligée que l’hyperkaliémie. Conclusions. Nos trois études convergent vers une probable méconnaissance du risque de gravité de l’hypokaliémie. L’ensemble de ces données confirme l’hypothèse d’une gestion sous-optimale des dyskaliémies, et principalement de l’hypokaliémie en médecine de ville, contribuant possiblement à sa prépondérance aux urgences, pour les patients non critiques. L’hypokaliémie représente une tueuse silencieuse et méconnue qu’il conviendrait de démasquer et de faire mieux connaître, pour un potentiel impact en terme de santé publiqueContext: Potassium disorders are frequent and associated with increased all-cause mortality, taking the form of a U-shaped curve. Nevertheless, there are little data on dyskalemia in the emergency department, especially in non-critical patients, even though it represents a significant part of the activity of emergency departments. Moreover, we have no data on the management of dyskalemia by general practitioners. Objectives: The objectives were to study the factors associated with dyskalemia in non-critical patients in the emergency department, and to learn about the practices of general practitioners and residents faced with the discovery of hyper or hypokalemia (known thresholds, management thresholds and attitude towards drugs with an action on kalemia). Methods: For the first article, we used data from a multi-center (11 emergency centers) cross-sectional observational study. For the second article, we conducted a telephone survey of 500 general practitioners throughout France. For the third article, we interviewed 357 general practice residents using self-administered questionnaires. Results: We described the factors associated with the presence of dyskalemia in emergency departments in patients presenting with non-critical medical condition. Dyskalemia is common and hypokalemia was found in almost 50% of patients. This proportion is higher than that described in populations with all emergency department visits, suggesting that hypokalemia is prevalent in non-critical patients. Hypokalemia in this population is associated with female gender and the use of thiazide diuretics. It is also associated with a poorer prognosis. Hyperkalemia was associated with angiotensin-aldosterone renin system blocker drugs and chronic renal failure. Our survey of 500 general practitioners in France shows that there is great heterogeneity in the management of dyskalemia by general practitioners and that some practices are not optimal, for example the non-biological control in case of hyperkalemia or the definitive discontinuation of proven cardiovascular-renal protection drugs. Our survey of residents revealed a great similarity of practices with those of practicing physicians. In fact, both in general practitioners and residents, the usual thresholds for dyskalemia are known and the differences reflect the different definitions found in the literature. The most salient result is the fact that hypokalemia seems to be more neglected than hyperkalemia. Conclusions: Our three studies converge on the basis that the risk of hypokalemia severity is probably not well known. All these data confirm the hypothesis that a sub-optimal management of dyskalemia, and mainly hypokalemia in primary care, may contribute to its preponderance in emergency rooms, for non-critical patients. Hypokalemia has a potential negative impact in terms of public health as it represents a silent and little-known killer that should be unmasked and exposed
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Stange, Dorit [Verfasser] y Dorothee [Akademischer Betreuer] Dartsch. "Effects of a structured medical management intervention aimed at reducing medication complexity during hospitalization in inpatient and subsequent outpatient care : a controlled trial under routine clinical conditions in chronically ill patients / Dorit Stange. Betreuer: Dorothee Dartsch". Hamburg : Staats- und Universitätsbibliothek Hamburg, 2012. http://d-nb.info/102757307X/34.
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Souza, Célia Alves de. "Mensuração da carga de trabalho de enfermeiros em central de quimioterapia". Faculdade de Medicina de São José do Rio Preto, 2012. http://bdtd.famerp.br/handle/tede/151.
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Previous issue date: 2012-05-11The increasing of attendances in the Chemotherapy Center has demanded from the nurses a better standard of time management and productivity. Considering this, the measurement of the work load becomes fundamental. This investigation, which is based on observation, has used the sample work technique and it presents the following aims: 1- identifying and validating the activities developed by nurses in a Chemotherapy Center and; 2- to measure the work load and productivity. The stage is a Chemotherapy Central placed in the South-East of Brazil. Nine assistant nurses have taken part (moments 1 and 2) and other seven of them (moments 3 and 4) during the period from May, 2010 to March, 2011. The study has been conducted in four moments: 1- identification of the interventions/activities, 2- validation of content, 3. pilot test and, 4- measuring of work load. In order to identify the activities performed by the nurses, a device was built using triangulation of data, combining three sources of information: semi-structured interview, documents analysis and questionnaire. The activities mapped have been categorized according to the language patterned by the Nurse Intervention Classification (NIC). Afterwards, the device has been submitted to content validation through meetings with the members. The final instrument was formed by 35 interventions and 48 activities organized in five areas (basic physiologic and complex physiologic, behaviorist, security and health system) and 11 classes. The pilot test using the instrument, conducted by two nurses during four consecutive days, has totaled 1000 samples and has resulted in 38 interventions and 88 activities. The sample size has been statistically established. The observations have been conducted during five days totalizing 1.487 samples of interventions/activities. It has been observed that 43,2% of the nurses time have been spent in indirect care, 33,2% indirect care, 11,6% in associated activities and 12% in personal activities. The average productivity has corresponded to 88%. This study has allowed the mapping and the validation of interventions/activities conducted during the attendance process. There has been concluded that nurses from the investigated unit have spent most of their time performing activities of indirect care. It has highlighted, furthermore, productivity indexes above the recommended ones present in the literature.
O aumento do volume de atendimento em central de quimioterapia tem exigido dos enfermeiros melhor gestão do tempo de trabalho e produtividade para atender a demanda. Dessa forma, a mensuração da carga de trabalho torna-se de fundamental importância. Essa investigação, de natureza observacional, utilizou técnica de amostragem de trabalho e teve como propósitos: 1- identificar e validar as atividades desenvolvidas por enfermeiros em Central de Quimioterapia e; 2- mensurar a carga de trabalho e produtividade. O cenário constitui-se em uma central de quimioterapia localizada na região sudeste do Brasil. Participaram do estudo nove enfermeiros assistenciais (momentos 1 e 2) e sete(momentos 3 e 4) durante o período de maio de 2010 a de março de 2011.O estudo foi realizado em quatro momentos: 1- identificação das intervenções/atividades, 2- validação de conteúdo, 3- teste piloto e, 4- mensuração de carga de trabalho. Para identificar as atividades realizadas pelos enfermeiros foi construído um instrumento utilizando triangulação de dados, combinando três fontes de informações: entrevista semiestruturada, análise de documento e questionário. As atividades mapeadas foram categorizadas segundo a linguagem padronizada pela Classificação de Intervenção de Enfermagem (NIC). Posteriormente, o instrumento foi submetido à validação de conteúdo através de reuniões com os participantes. O instrumento final foi composto por 35 intervenções e 48 atividades organizadas em cinco domínios (fisiológico básico e fisiológico complexo, comportamental, segurança e sistema de saúde) e 11 classes. O teste piloto com o instrumento, conduzido por duas enfermeiras durante quatro dias consecutivos, totalizou 1000 amostras e resultou em 38 intervenções e 88 atividades. O tamanho amostral foi estabelecido estatisticamente. As observações foram conduzidas durante cinco dias totalizando 1.487 amostras de intervenções/atividades. Observou-se que 43,2% do tempo dos enfermeiros foram consumidos em cuidados indiretos, 33,2% em cuidados diretos, 11,6% em atividades associadas e 12% em atividades pessoais. A produtividade média correspondeu a 88%. Este estudo permitiu mapear e validar as intervenções/atividades realizadas durante o processo assistencial. Concluiu que enfermeiros da unidade investigada consumiram a maior parte de seu tempo em atividades de cuidados indiretos. Revelou, ainda, índice de produtividade acima dos recomendados na literatura.
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Chitete, Lusungu. "Uptake of HIV testing among acutely malnourished children in dowa district of Malawi". University of Western Cape, 2013. http://hdl.handle.net/11394/3928.
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Magister Public Health - MPHAim: This study sought to investigate service-related factors that affect uptake of HIV testing among children enrolled in CMAM. This was a descriptive study that used mixed quantitative and qualitative methods. To assess uptake of HIV testing records were reviewed of number of children tested as a percentage of number of children enrolled in CMAM over 12-month period in a sample of health facilities. Face to face in-depth interviews were conducted of CMAM and HTC focal persons to investigate factors affecting uptake. Information from interviews was analyzed using a thematic approach.
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Liang, Shu-Yuan. "Opioid-taking self-efficacy in Taiwanese Outpatients with cancer pain". Thesis, Queensland University of Technology, 2007. https://eprints.qut.edu.au/16516/1/Shu-Yuan_Liang_Thesis.pdf.
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Despite the fact that as many as 80-90% of patients with cancer pain can be effectively treated using pharmacological therapies and other advanced approaches, 31% to 85% of cancer patients in Taiwan still experience varying levels of pain. Pain is one of the symptoms that patients fear most; it overwhelms all aspects of patients' lives and creates a sense of uncertainly and hopelessness. Pain control is, therefore, a high priority in the treatment of cancer patients. Pharmacological therapy is the cornerstone of cancer pain management. With the current trend toward outpatient care, many patients are being required to assume greater responsibility for self-management of prescribed analgesics at home to deal with the variable and complex nature of cancer pain and side effects of opioids. Patients however, have misconceptions regarding analgesics and a series of difficulties when attempting to put a pain management regimen into practice.
This research addressed the hypothesis that self-efficacy beliefs might play an important role in analgesic adherence and pain experience in Taiwanese outpatients with cancer. The purpose of this study was to develop a scale to measure the self-efficacy expectations relating to opioid-taking in Taiwanese outpatients with cancer. Another purpose was to explore how opioid-taking self-efficacy and beliefs about opioid analgesics contribute to patients' analgesic adherence and pain experience in Taiwanese outpatients with cancer.
In the first stage semi-structured interviews were conducted to collect data from a purposeful sample (n=10) of oncology outpatients from two teaching hospitals in the Taipei area of Taiwan. The purpose of this phase was to identify behaviours and situational impediments associated with analgesic taking. Findings from this phase were used to develop a scale to measure opioid-taking self-efficacy. In the second stage a pilot test with a convenience sample (n=30) was conducted to test the validity and reliability of the new scale and to identify the feasibility of using the scale in a cross-sectional survey. In the third stage a cross-sectional survey was undertaken (n=92) to describe pain experiences, analgesic adherence, beliefs about opioid analgesics, and opioid-taking self-efficacy in Taiwanese outpatients with cancer and to explore how opioid-taking self-efficacy and beliefs about opioid analgesics contributed to analgesic adherence and pain experience.
Results of this study highlight an important issue - under-treatment of cancer pain in this group of Taiwanese outpatients. As well, low adherence rates to opioid analgesics in cancer outpatients arose as an important issue in this study. A range of misconceptions about using opioids for pain was also common amongst the sample. Despite these misconceptions, patients reported being moderately confident in their ability to perform self-management behaviours related to their prescribed opioid-taking. Results of this research supported the notion that patients' self-efficacy in relation to taking their prescribed opioid regimen was a significant independent predictor of patients' adherence behaviour and pain relief, but not of pain severity. Beliefs about opioid analgesics were also an independent predictor of patients' adherence, but not of pain relief or pain severity. In addition, findings from this study provided support for the validity and reliability of the opioid-taking self-efficacy scale.
Results suggested there is a need for systematic assessment of beliefs affecting patients' opioid adherence behaviours for cancer pain control, including perceived personal self-efficacy and beliefs about opioid analgesics. Educational programs that focus on overcoming patients' misconceptions (beliefs) about taking opioid analgesics may be particularly beneficial. In addition, this study advocates that conducting self-efficacy-enhancing interventions may improve medication adherence for patients and therefore pain relief. More research is needed to demonstrate the construct validity of the self-efficacy scale and to evaluate self-efficacy enhancing interventions in cancer pain management.
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Liang, Shu-Yuan. "Opioid-taking self-efficacy in Taiwanese Outpatients with cancer pain". Queensland University of Technology, 2007. http://eprints.qut.edu.au/16516/.
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Despite the fact that as many as 80-90% of patients with cancer pain can be effectively treated using pharmacological therapies and other advanced approaches, 31% to 85% of cancer patients in Taiwan still experience varying levels of pain. Pain is one of the symptoms that patients fear most; it overwhelms all aspects of patients' lives and creates a sense of uncertainly and hopelessness. Pain control is, therefore, a high priority in the treatment of cancer patients. Pharmacological therapy is the cornerstone of cancer pain management. With the current trend toward outpatient care, many patients are being required to assume greater responsibility for self-management of prescribed analgesics at home to deal with the variable and complex nature of cancer pain and side effects of opioids. Patients however, have misconceptions regarding analgesics and a series of difficulties when attempting to put a pain management regimen into practice. This research addressed the hypothesis that self-efficacy beliefs might play an important role in analgesic adherence and pain experience in Taiwanese outpatients with cancer. The purpose of this study was to develop a scale to measure the self-efficacy expectations relating to opioid-taking in Taiwanese outpatients with cancer. Another purpose was to explore how opioid-taking self-efficacy and beliefs about opioid analgesics contribute to patients' analgesic adherence and pain experience in Taiwanese outpatients with cancer. In the first stage semi-structured interviews were conducted to collect data from a purposeful sample (n=10) of oncology outpatients from two teaching hospitals in the Taipei area of Taiwan. The purpose of this phase was to identify behaviours and situational impediments associated with analgesic taking. Findings from this phase were used to develop a scale to measure opioid-taking self-efficacy. In the second stage a pilot test with a convenience sample (n=30) was conducted to test the validity and reliability of the new scale and to identify the feasibility of using the scale in a cross-sectional survey. In the third stage a cross-sectional survey was undertaken (n=92) to describe pain experiences, analgesic adherence, beliefs about opioid analgesics, and opioid-taking self-efficacy in Taiwanese outpatients with cancer and to explore how opioid-taking self-efficacy and beliefs about opioid analgesics contributed to analgesic adherence and pain experience. Results of this study highlight an important issue - under-treatment of cancer pain in this group of Taiwanese outpatients. As well, low adherence rates to opioid analgesics in cancer outpatients arose as an important issue in this study. A range of misconceptions about using opioids for pain was also common amongst the sample. Despite these misconceptions, patients reported being moderately confident in their ability to perform self-management behaviours related to their prescribed opioid-taking. Results of this research supported the notion that patients' self-efficacy in relation to taking their prescribed opioid regimen was a significant independent predictor of patients' adherence behaviour and pain relief, but not of pain severity. Beliefs about opioid analgesics were also an independent predictor of patients' adherence, but not of pain relief or pain severity. In addition, findings from this study provided support for the validity and reliability of the opioid-taking self-efficacy scale. Results suggested there is a need for systematic assessment of beliefs affecting patients' opioid adherence behaviours for cancer pain control, including perceived personal self-efficacy and beliefs about opioid analgesics. Educational programs that focus on overcoming patients' misconceptions (beliefs) about taking opioid analgesics may be particularly beneficial. In addition, this study advocates that conducting self-efficacy-enhancing interventions may improve medication adherence for patients and therefore pain relief. More research is needed to demonstrate the construct validity of the self-efficacy scale and to evaluate self-efficacy enhancing interventions in cancer pain management.
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Gomes, Cristiano Freitas. "Gestão de custos em uma clínica popular multiprofissional de serviços de saúde: uma abordagem para a implementação de um sistema de custo". Universidade Nove de Julho, 2014. http://bibliotecadigital.uninove.br/handle/tede/1175.
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It is known that the complexities of large hospital sectors require large amount of resources for their implementation and operation, and the equipment end up having relatively short lifespan and spending are too high for the characteristic of the patients treated, unlike outpatient specialties where the cost is returned to skilled labor. Currently, health services have sought to control your spending. Every day the modern environment has been shown in favor of change and competitiveness not only for quality but at a lower cost has been considered. Propose a system of cost management for health clinics popular services that assists managers can have a better competitive position in the negotiations. The objective this study was to analyze the process of management of costs by absorption costing, in popular multi-professional clinical health services. This research is the research-action type. The data had been collected through primary documents and analyzed by documentary and descriptive analysis. The absorption costing takes care of requirements of Management of Costs National Program (PNGC). This is a easy method to standardize the costs information units that were managed.
Agradeço inicialmente a Deus, em Quem eu acredito e confio, por mais esta vitória. Aos meus avós Lage e Amélia (in memorian), meus tios Heitor e Gilza, tios Rubio (in memorian) e Ster, tia Aparecida e seus respectivos filhos e filhas, meus primos e primas, que foram sempre em algum momento da minha vida um exemplo do bem, foram aquele apoio para que eu seguisse adiante mesmo que a vida insistisse em me mostrar o contrário. Aos meus padrinhos Orlando (in memorian) e Carmem Quintela por terem estado ao meu lado e de minha mãe no início, o que foi determinante para que eu chegasse até aqui. À Família Giacomin, nas pessoas de Sr. Alberto, Marilda, Tiago, Carol e Lelê. No momento crucial para minha carreira profissional vocês surgiram, acreditaram em mim e me permitiram sonhar alto, mesmo eu pensando que não mais seria possível voar mais alto. Vocês permitiram transformar um sonho em realidade. Sem palavras! Eterna gratidão. Aos meus sogros Francisco (Chicão) e Delza pela parceria desde os tempos difíceis, mas extremamente prazerosos e felizes, pela minha ―adoção‖ mesmo que de forma repentina sempre muito acolhedora e verdadeira, por serem nossos amigos e apoiadores de todos os sonhos e devaneios, por mais surreal que possam parecer. À minha orientadora Prof.ª Chennyfer Dobbins da Rosa, parceira desde 2012, agradeço pelo convite, pelo apoio e por me permitir seguir adiante mesmo eu pensando que não iria conseguir. Muito obrigado! Esse título tem muito de seu apoio, você sabe disso. A todos meus colegas de mestrado, e em especial aos amigos: Thaissa, Camille, Adriana, Sérgio e Marília pela parceria desses dois anos que parece ter iniciado ontem. Valeu muito! A todos os professores e professoras do MPGSS/U9 que estiveram conosco por esses dois anos nos ensinando e incentivando. Finalmente a todos meus amigos, amigas e pacientes da Clínica Dr. Família, objeto desse estudo, nossos parceiros, colaboradores e apoiadores, e em especial à minha sócia e querida amiga Regina Maura Zetone pela união leal e perene, por sempre estar junto nesse sonho que virou realidade. Gente que cuida de gente! Que Deus siga nos abençoando. #tamojunto! RESUMO É sabido que os setores hospitalares de grande complexidade demandam a gestão dos recursos para sua implantação e operação, uma vez que os equipamentos acabam tendo vida útil relativamente curta e os gastos são demasiadamente altos pela própria característica dos pacientes atendidos, diferente dos ambulatórios de especialidades, onde o custo está voltado à mão de obra qualificada. Atualmente, os serviços de saúde têm buscado controlar seus gastos, visto que a cada dia o ambiente moderno tem se mostrado a favor das transformações; e a competitividade, não só por qualidade mas também por menor custo, tem sido considerada. Propor um sistema de gestão de custos para clínicas de serviços de saúde populares auxilia que os gestores consigam ter melhor capacidade competitiva nas negociações. O objetivo deste trabalho foi analisar o processo de gestão de custos, por meio do custeio por absorção, de uma clínica popular multiprofissional de serviços de saúde. A pesquisa é do tipo pesquisa-ação. Os dados foram coletados em documentos primários e analisados por meio de análise descritiva e documental. O custeio por absorção atende às exigências do Programa Nacional de Gestão de Custos (PNGC), sendo um método fácil de padronização das informações de custo administradas.
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Brumm, Susan D. "Readmissions, Telehealth, and a Handoff to Primary Care in Veterans with Diabetes". Xavier University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=xavier1524395520207456.
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ZINI, ELISA MARIA. "Exploitation of Patient-Reported Outcomes in the management of cancer outpatients: integration of mobile technology and digital guidelines". Doctoral thesis, Università degli studi di Pavia, 2019. http://hdl.handle.net/11571/1242426.
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Henderson, Wendy M. "User satisfaction in PFI and non-PFI hospitals in the UK : in particular the outpatients' department reception/waiting areas". Thesis, University of Bedfordshire, 2008. http://hdl.handle.net/10547/300624.
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Few studies have been undertaken which examine the correlation between design of the receptionl/waiting areas of the outpatients' departments and the implications for Private Finance Initiative (PFI) and non-PFI hospitals, in particular the interior environment with reference to user satisfaction. This study investigates to what degree user satisfaction has been achieved in the design of the receptionlwaiting areas in PFI and non-PFI hospitals. The aim of the investigation is to determine whether user satisfaction can be achieved in PFI or non-PFI hospital environments, particular in the outpatients' department. To ascertain whether hospital environments facilitate user friendly and therapeutic characteristics/attributes conducive to user satisfaction, two strands of investigation were undertaken; a) investigation and analysis of PFI and non-PFI hospital design; b) the study of users (PFI and non-PFI) via questionnaire surveys and analysis of their perceptions. The research methods utilised combinations of qualitative information from interviews, discussions with hospital end users, architects/designers and Consortium executives. The surveys undertaken with patients, hospital staff and NHS Trust Managers provided quantitative data to measure the degree to which user satisfaction had been achieved. The main findings of the design analysis identify the strengths and weaknesses in the design of the 'main' and 'sub' reception/waiting areas respectively. The results of the patient surveys, discussions and interviews revealed more positive perceptions of the hospital facilities for PFI hospitals and a general acceptance of the hospital facilities in the non-PFI hospitals. However, the other comments section of the questionnaires reveals some psychological needs of the user were not being met. The hospital staff surveys, discussions and interviews revealed the spatial planning was not ideal for their functional needs. The survey of NHS Trust Managers, Architects/Designers and Building Contractors revealed the difficulties associated with the collaborative process and the implications for the design development process, when reflecting upon 'cost effectiveness' and 'value for money' issues. The conclusions drawn from the study suggest that there is a case for the standardisation of therapeutic environments in the development of 'new build' hospital projects via the design development and collaborative process. The recommendation (see p. 313) provides a design protoeo/that enhance and aids the design development process via selective expertise, which addresses the functional and psychological needs of the hospital end user.
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Mayanja, Frederick James Lutwana Bugembe. "A study of patients' perceptions of quality of care at the Department of Outpatients in the Eastern Cape District Hospital". Thesis, Stellenbosch : University of Stellenbosch, 2009. http://hdl.handle.net/10019.1/8574.
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Thesis (MBA)--University of Stellenbosch, 2009.ENGLISH ABSTRACT: The aim of the study was to assess the adult patients' perception of the quality of care received, following a visit to a doctor at Mthatha General Hospital Outpatients Department to establish whether it meets the patients' expectations, and to derive recommendations to improve the quality and assure that it is maintained. A cross-sectional survey was used to obtain the relevant data. A structured interview questionnaire was administered to a systemic sample of 204 adult patients attending the General Outpatients clinic at Mthatha General Hospital after a consultation with a doctor. Data was gathered and analyzed on the 204 patients' records using a Statistical package for Social sciences. This study has revealed that most patients are female (59%), aged between 16 and 70 years, with the majority in the 41 to 50 year age group. The majority of patients are unemployed (55.4%), with grade 1-8 level of education, have presence of long-standing illness or disability (54.9%), and are married (53.4%). The patients' perception of the quality of care was positive. The interpersonal aspects of care was judged by patients to be the most important, followed by technical aspects. Socio-demographic influences on perception of care were significant in those patients with long-standing illness or disability in respect of outcome aspects of care. It is recommended that patients' perception of the care provided to them be periodically assessed to ascertain if it meets their needs.
AFRIKAANSE OPSOMMING: Die doel van die studie was om die volwasse pasient se persepsie van die kwaliteit van versorgingsdiens, soos ervaar na 'n besoek aan 'n dokter by die Mthatha Algemene Hospitaal Buitepasiente Afdeling, te bepaal om gevolglik vas te stel of aan die pasient se verwagtinge voldoen is en om aanbevelings hiervan af te lei om kwaliteit te verbeter en te verseker dat dit volgehou word. 'n Deursnee peiling is gebruik om toepaslike data te bekom. 'n Gestruktureerde onderhoud-vraelys is aan 'n sistemiese monster van 204 volwasse pasiente by die algemene buitepasiente kliniek van die Mthatha Algemene Hospitaai gedoen na 'n besoek aan 'n dokter. Data uit die 204 pasienterekords is versamel en analiseer deur middel van 'n statistiese pakket vir die sosiale wetenskappe. Resultate toon dat die meerderheid pasiente vroulik (59%) en tussen 16 en 70 jaar oud is en oorwegend in die 41 tot 50 jaar ouderdomsgroep val. Die meerderheid pasiente is werkloos (55.4%), het 'n graad 1-8 vlak-opvoeding, vertoon met 'n langtermyn siekte toestand of ongeskiktheid (54.9%) en is getroud (53.4%). Die pasiente se persepsie van die kwaliteit van versorging was positief. Interpersoonlike aspekte van versorging is deur pasiente as die belangrikste beskou, gevolg deur tegniese aspekte. Sosiodemografiese invloede op die persepsie van uitkoms-verwante aspekte van versorging was betekenisvol by pasiente met langtermyn siekte toestande of ongeskikthede. Daar word aanbeveel dat pasiente se persepsie aangaande die versorging wat hulle ontvang periodiek beoordeel word om vas te stel of aan hulle behoeftes voldoen word.
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Skerman, Helen Mary. "Alternative analytical methods for the identification of cancer-related symptom clusters". Thesis, Queensland University of Technology, 2010. https://eprints.qut.edu.au/34503/1/Helen_Skerman_Thesis.pdf.
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Advances in symptom management strategies through a better understanding of cancer symptom clusters depend on the identification of symptom clusters that are valid and reliable. The purpose of this exploratory research was to investigate alternative analytical approaches to identify symptom clusters for patients with cancer, using readily accessible statistical methods, and to justify which methods of identification may be appropriate for this context. Three studies were undertaken: (1) a systematic review of the literature, to identify analytical methods commonly used for symptom cluster identification for cancer patients; (2) a secondary data analysis to identify symptom clusters and compare alternative methods, as a guide to best practice approaches in cross-sectional studies; and (3) a secondary data analysis to investigate the stability of symptom clusters over time. The systematic literature review identified, in 10 years prior to March 2007, 13 cross-sectional studies implementing multivariate methods to identify cancer related symptom clusters. The methods commonly used to group symptoms were exploratory factor analysis, hierarchical cluster analysis and principal components analysis. Common factor analysis methods were recommended as the best practice cross-sectional methods for cancer symptom cluster identification. A comparison of alternative common factor analysis methods was conducted, in a secondary analysis of a sample of 219 ambulatory cancer patients with mixed diagnoses, assessed within one month of commencing chemotherapy treatment. Principal axis factoring, unweighted least squares and image factor analysis identified five consistent symptom clusters, based on patient self-reported distress ratings of 42 physical symptoms. Extraction of an additional cluster was necessary when using alpha factor analysis to determine clinically relevant symptom clusters. The recommended approaches for symptom cluster identification using nonmultivariate normal data were: principal axis factoring or unweighted least squares for factor extraction, followed by oblique rotation; and use of the scree plot and Minimum Average Partial procedure to determine the number of factors. In contrast to other studies which typically interpret pattern coefficients alone, in these studies symptom clusters were determined on the basis of structure coefficients. This approach was adopted for the stability of the results as structure coefficients are correlations between factors and symptoms unaffected by the correlations between factors. Symptoms could be associated with multiple clusters as a foundation for investigating potential interventions. The stability of these five symptom clusters was investigated in separate common factor analyses, 6 and 12 months after chemotherapy commenced. Five qualitatively consistent symptom clusters were identified over time (Musculoskeletal-discomforts/lethargy, Oral-discomforts, Gastrointestinaldiscomforts, Vasomotor-symptoms, Gastrointestinal-toxicities), but at 12 months two additional clusters were determined (Lethargy and Gastrointestinal/digestive symptoms). Future studies should include physical, psychological, and cognitive symptoms. Further investigation of the identified symptom clusters is required for validation, to examine causality, and potentially to suggest interventions for symptom management. Future studies should use longitudinal analyses to investigate change in symptom clusters, the influence of patient related factors, and the impact on outcomes (e.g., daily functioning) over time.
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Lucas, D. Pulane. "Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital". VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/2996.
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Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs.
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Li, Min Zhen y 李敏禎. "The management of outpatient visit waiting time". Thesis, 1995. http://ndltd.ncl.edu.tw/handle/70346687851657591463.
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Yedehalli, Venkataramu Raghunandan Yildirim Mehmet B. "A revenue management framework for appointment allocation in rehabilitation outpatient clinics". Diss., 2005. http://il.proquest.com/products_umi/dissertations.
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Thesis (M.S.)--Wichita State University, College of Engineering."December 2005." Title from PDF title page (viewed on April 23, 2007). Thesis adviser: Mehmet B. Yildirim. UMI Number: AAT 1436593 Includes bibliographic references (leaves 57-58).
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Yedehalli, Venkataramu Raghunandan. "A revenue management framework for appointment allocation in rehabilitation outpatient clinics". Thesis, 2005. http://hdl.handle.net/10057/780.
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Rehabilitation outpatient clinics help patients overcome physical disabilities through various rehabilitation services. Appointment scheduling and accepting new patients are very important processes in rehabilitation outpatient clinics. In this thesis, several mathematical models for generating optimal appointment schedules with an objective to maximize the profit when demand is deterministic are developed. In these models, the possibility of treating more than one patient simultaneously is also considered. In this case, grouping patients results in the minimal use of part time therapists. When the demand is stochastic, a revenue management framework to allocate appointments is proposed. Using the proposed revenue management framework, the revenue and overall profit generated is maximized. To test the effectiveness of this framework, extensive simulation study is performed. Analysis of mathematical and simulation models reveal that the proposed methodologies result in an increased revenue and profit when the capacity is tight and demand is high. The revenue management framework also increases the number of new customers accepted for treatment in an outpatient clinic significantly.Thesis (M.S.)--Wichita State University, College of Engineering, Dept. of Industrial and Manufacturing Engineering
"December 2005."
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Shiu, Shu-Chuen y 許淑純. "The Influences of Medical Team Resource Management on Outpatient Satisfaction and Loyalty". Thesis, 2012. http://ndltd.ncl.edu.tw/handle/82817477507160294785.
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碩士嶺東科技大學
經營管理研究所
100
The good relationship used to health care institutions to actively promote all kinds of management reform strategy to establish and maintain patient closely,Long-term and stable relationships of interaction is to win customer satisfaction and loyalty in an effective way, is an important asset of the organization is different from competitors. The purpose of this study investigated the resource management of health care team effects on outpatient satisfaction and loyalty in Changhua County Regional Teaching Hospital. This study adopted a quasi-experimental design and conducted a questionnaire survey to collect empirical data. This study was collected total of 260 outpatients which about the hospital environment and facilities, waiting times, staff attitude,and medical procedures, the results analysis of service satisfaction and loyalty ,before and after medical team resource management programs adoption . The major findings of this study ware as follows: 1.The increase of outpatient satisfaction of the hospital environment and facilities, waiting times, staff attitude, medical procedure, was define after adoption of medical team resource management programs; 2.The high level loyalty of customer to the outpatient hospital was define after adoption of medical team resource management programs.
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Hung, Fang-Ling y 洪芳玲. "The Effectiveness of Applying Case Management for Patients with Hypertension at an Outpatient Department". Thesis, 2003. http://ndltd.ncl.edu.tw/handle/27989556974117036517.
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碩士臺北醫學大學
護理學系
91
With the increasing changes in health care environment and health policies, hospitals need to found effective strategies such as case management care model to control costs and to improve patient care. Therefore, the purposes of this study were to explore and compare the differences among self-care knowledge, daily health behaviors, and blood pressure control between case management group and control group for hypertensive patients at an outpatient department. The design was quasi-experimental using a purposive sampling. The time of weekly outpatient visit was used to assign subjects to case management group or control group. The data collection period was from January to June of 2003. Subjects were outpatient hypertensive patients who met criteria for inclusion in this study and from a district teaching hospital in Taipei areas. The case management care model was only implemented in a case management group. But the usual care model was used in a control group. The demographics of the subjects and pre-test data including the level of self-care knowledge, daily health behaviors, and blood pressure were collected before implementation of care management care model. Post-test data were collected after 3-month of implementation. Regular outpatient visits and blood pressure were collected from patient charts. Data were managed using SPSS 10.0 version for Windows and SAS 8.0 version for Windows and analyzed using Chi-square test and independent t-test for demographics data, and Generalized Estimating Equations (GEEs) to compare the differences between these two groups before and after implementing the case management care model. Thirty subjects were in case management group and 25 subjects were in control group. The results indicated that there was no significant difference among the level of self-care knowledge (p=.687), daily health behaviors (diet; p=.802, exercise; p>.05, and medication compliance; p= .160), and regular outpatient visits (p=.493) between these two groups. However, the ratio of blood pressure control to normal (<140/90 mmHg) was higher in case management group than in control group and showed a significant difference (p= .011). The findings of this study can not only serve as a reference for health care providers to provide case management care for hypertensive patients, but also to develop a case management care model for other chronic diseases at outpatient departments.
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Fang, Shu-Yun y 方淑雲. "The impact of hospital autonomous management on outpatient prescription drug patterns：case of diabetes patients". Thesis, 2005. http://ndltd.ncl.edu.tw/handle/15239928576042337683.
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碩士長庚大學
醫務管理學研究所
93
The implementation of global budget may impose substantial impacts on hospital operation. Bureau of National Health Insurance aims to stabilize the point value for payment with a view to mitigate the potential perversive effect on patients’ access to quality of care that global budget may cause. The policy intervention undertaken is to encourage hospitals which have shown satisfactory track record in quality performance or willingness to participate in the hospital autonomous management project. To understand the impact of the hospital autonomous management policy on prescription drug pattern, this study adopted “Difference-in-Difference” method to assess the changes in diabetic drug prescription, further to investigate the possible policy effects. The analytical sample of 117,997 diabetic patients were gathered and screened from a claim data filed to Bureau of National Health Insurance Taipei Branch Office between 2002 and 2004. The main inclusion criterion is the diabetic patients have to be treated at the same hospital outpatient department during the study period. The hospitals chose to participate in the hospital autonomous management project starting January 2004 are treated as the experiment group (totaling 22 hospitals) while those chose not to participate are classified as control group (totaling 79 hospitals). The major findings of this study are summarized as follows: 1. By hospital accreditation status: Except for the third quarter of 2004, medical centers and regional hospitals in the experiment group compared to those in the control group appear to decrease more in average number of outpatient visits. In contrast, the average daily drug expenditure, average daily diabetic drug expenditure, average prescribed days per visit, and average items per prescription, increase more in the experiment group hospitals than those in the control group. 2. By hospital ownership: the public hospitals in the experiment group has shown a higher increase in the average daily drug expenditure and average daily diabetic drug expenditure compared to those public hospitals in the control group; in contrast, the proprietary hospitals in the experiment group appear to demonstrate a less degree of increases than those in the control group. 3. Change in the distribution of diabetic drug: a decrease in the percentage of diabetic drugs with an average unit price below NT$5 and above NT$10 is detected between 2002 and 2004, but the percentage of those with average unit price between NT$5 and 9 have increased, indicating that the unit price of diabetic drugs appear to converge to middle price range. Keywords: diabetes, hospital autonomous management, Differences-in-Differences, prescription pattern
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Zheng, Ming-Jie y 鄭明傑. "Application of Data Mining Technique to Inventory classification management of Outpatient Services of Hospitals". Thesis, 2011. http://ndltd.ncl.edu.tw/handle/86079767350310308689.
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碩士國立高雄第一科技大學
運籌管理研究所
99
The purpose of the study is to explore the optimum medical articles inventory control in medical organization. It is not easy to well control medical articles inventory due to multi-item factors and huge quantity in a medical organization. Reasonable stock is a need for medical staffs and patients by keeping all medical articles available, moreover, to fulfill medical business implementation and not to affect the right of patient by shortage of medical articles. Meanwhile, It also has a benefit not to increase cost, since the prediction of possible shortage cause over purchase. The first step to succeed controlling the medical inventory control is the precious categorized of inventory and distribute right medical articles, quantities to correct department accurately., it will be the first step to do the successful stock control. In traditional idea, the cost is always be considered as decision variable. Decision variable always considered the cost in traditional perception.Based on the amount of cost of the inventory management in a planning cycle (eg. a quarter) to calculating the total inventory items and the total amount of inventories ratio will be classified to make different inventory management strategies for each catalog. ABC analysis is the typical method.There are hundreds of variable pharmaceutical materials in medical institution, hence, large amount of transaction data and important information will be ignored if the inventory clustering is still decided by the traditional cost approach. It is hard to detect all the special meaning relevant the "optimum inventory control" in the information. Furthermore, the study widely utilize the association rules on data mining of the medical transaction database, in order to derive a single assist stock association rule on the classification categories, and then submits the evaluation of ABC classification and the relationship on inventory analysis as an important reference for decision-making. In this study, 476,177 of data extracted from National Health Insurance files range from January to March, 2010, the unit is monthly and in the multi-level concept, MIS = 0.001%, MIC = 50%, the results are 19 association rules (actually 15, because there are four effects are interrelated).According to ABC analysis of inventory control table, we can get a lot of data from a sub-model and set up a priority relationships. In conclusion, with techniques, we will find large database- difficult to detect the relationship, and it will provide management staff to make timely inventory management policies.Many information can get from a subordinated model based on ABC analysis table of inventory to establish medical utilizing model and priority. In conclusion, apply data mining technique to find out the potential relationship in a huge database which can provide managing staff to adjust inventory policies timely.
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Chiou, Wan-Fen y 丘婉芬. "Evaluation of Asthma Disease Management Program for Asthma Outpatient in a Medical Center of Central Taiwan". Thesis, 2014. http://ndltd.ncl.edu.tw/handle/fb4d5m.
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碩士中臺科技大學
護理系碩士班
102
Asthma is a severe health issue in the worldwide. Asthma’s prevalence and its medical cost were also increasing rapidly. Thus, in order to enhance the care of asthma patients, Central Health Insurance Bureau to comprehensive health care benefits “Asthma Management Program” in November 2001. This study had two aims. First, the program effects on the self-care ability, asthma control, the quality of life and the frequency of hospitalizations in individuals who participated at the “Asthma Management Program”, Secondly, the predictive factors of the program outcomes were further explored. This study used longitudinal design with convenient sampling method. Thirty patients from chest department of a medical center that join the Asthma Management Program participated at this study. Adult Asthma Self-Care Behavior Scale, Asthma Quality of Life Questionnaire (AQLQ), Asthma Control Test and Demographic Data Sheet were used to collect data form participants. Data were collected at before enrollment of the program, 1- , 3- and 6-month after enrollment. The results showed improved self-care ability, better asthma control and better quality of life in participants who attended Asthma Management Program. It also got improved with increased disease management time. However, no significant decreases in the frequency of hospitalization were noted at first、third and the sixth months after participated at the program. Age was the predictor of the outcomes of the Asthma Disease Management Program,51-65 years group’s asthma control is better them those in group of 18-30 years. The study has revealed that asthma control required long-term-and continuous care. An effective disease management model should be designed to include comprehensive asthma health education program to meet patient’s need. Based on our study, the predict factors of adult Asthma Disease Management Program can be a reference for interventions for all medical members.
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Jones, Eric Allen. "Outpatient antibiotic use for acute respiratory tract infections: seasonal trends, and implications for care & quality". Thesis, 2021. https://hdl.handle.net/2144/41908.
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Acute respiratory tract infection (ARI) is the most common reason for outpatient medical visits in the United States, and frequently results in treatment with an antibiotic. Most ARIs have a viral etiology, thus antibiotic therapy will have little clinical benefit in these cases. It is estimated as much as one-half of all antibiotic utilization for ARI in outpatient settings is inappropriate. Importantly, this misuse is thought to be the primary driver of antibiotic resistance development among bacteria. Antibiotic resistant infections cause an estimated 2 million illnesses and 23,000 deaths annually in the United States, and associated costs exceed $30 billion. Despite our current understanding of relevant predictors of appropriate antibiotic use, less is known regarding seasonality. This dissertation explores effects of seasonality on antibiotic prescribing in three aspects: 1) seasonal variation in appropriateness of prescribing, and antibiotics prescribed among common ARIs; 2) specific predictors of observed seasonal variation in prescribing practices; and 3) implications of seasonality for guideline concordance & quality of care. Findings generated herein, could help inform interventions designed to promote more judicious use of antibiotics in healthcare.
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Camara, Ousman y 歐思孟. "Outpatient Copings and Performance of Nurses in Integrated Management of Childhood Illness in three Health Regions of The Gambia". Thesis, 2011. http://ndltd.ncl.edu.tw/handle/41112822316835572991.
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碩士國立臺北護理健康大學
護理研究所
99
This quantitative research study had utilized a descriptive correlation design to examine the relationship between demography, workplace, children’s symptoms, job coping, and work performance of nurses in IMCI. Data was collected through observing nurses managing the sick child and “Gold Standard made through re-examination by researcher. Caregivers were interview (exit interview) to assess their level of understanding on advice given to them and self administration of Occupational Coping Self Efficacy questionnaire by nurses. The study revealed that nurses had coped well with a mean coping of 3 (easy to cope with it). However coping had no relationship with performance. The assessments of children were often incomplete. Less than three-quarter of classifications met gold standard as well as treatment. The counseling performance of nurses was unsatisfactory. Children’s symptoms and some demographic variables had correlated with some performances. As far as prediction, registered nurses and children’s symptoms variables were considered best predictors of some performance areas.
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Chang, Chiung-Ying y 張瓊媖. "Healthcare Seeking Behavior and Cost of Outpatient in Schizophrenia Case Management Plan: An Example of a Regional Teaching Hospital". Thesis, 2012. http://ndltd.ncl.edu.tw/handle/13320165179630848700.
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碩士元智大學
資訊管理學系
100
This thesis is developed to investigate the 2010 launch of the " Healthcare Seeking Behavior and Cost of Outpatient in Schizophrenia Case Management Plan: An Example of a Regional Teaching Hospital". Statistical analyses were performed using SPSS 12.0 of the statistical software. (1) By using the pair-t test to compare the case management plan before and after the 588-case result, it showed that per person psychiatric outpatient expenditure, psychiatric outpatient medical visits, the per person psychiatric inpatient expenditure, and inpatient psychiatric hospital days were in a downward trend and no significant differences. But the outpatient psychiatric clinic fee and the number of inpatient psychiatric medical treatment were significantly different. (2) the post-test to participate or not Schizophrenia case management plan had no significant statistical difference compared with non-participation in case management plan outpatient per person medical costs per person medical expenses per person medical fees for the effective control has grown up (3) the family support’s behavior on the implementation of psychiatric case management plan were significantly different at psychiatric outpatient expenditure and medical fee. So, the psychiatric outpatient parts (medical cost, medical fee, and medical visits) and the psychiatric inpatient parts (medical cost, medical fee and hospital days) were reduced than past. This is useful to increase the medical efficiency at the payment system’s early stage in implementing the schizophrenia case management plan. Besides, on the points of the overall payment, family-support behavioral for medical cost were belong to helping patients actively and no family helping, or almost rejected any type cooperation. Therefore, it was helpful for patients to focus on disease awareness, reduce hospitalization and medical visits when implementing the case management plan.
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Yeh, Ching-Yi y 葉靜宜. "The Effectiveness of Applying Disease Management for Patients with Hypertension in An Outpatient Department---Based on A District Teaching Hospital". Thesis, 2008. http://ndltd.ncl.edu.tw/handle/98478860459780732134.
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碩士國立台北護理學院
護理研究所
96
Abstract Hypertension is one of the most prevailing chronic diseases in the world. The prevalence in Taiwan is getting higher each year. In addition to control with medication, life style adjustment is also suggested to be included in the treatment plan. The current health education protocol in OPD provided only segmental reminders than individualized instruction on daily practice. To fulfill the needs, this study intended to implement and evaluate the effects a nurse developed disease management protocol on hypertension self-care knowledge, daily health care behaviors, blood pressure and self-efficacy of health related behaviors among hypertension patients. A quasi-experimental design were applied, total 58 OPD hypertension patients were recruited and assign into experimental (n=28) and control group(n=30). The intervention were an 8week group activities with two hours per week, compared to regular OPD care for the control group. The research instruments included questionnaires for hypertension knowledge, self efficacy, blood pressure data, and weekly exercise logs. Data was collected at one week before and after the intervention for both group. In order to evaluate the residual effect of the experimental group, extra measurement was done in one month after intervention. After the data cleaning, the SPSS 12.0 package software was applied and percentile, means, standard difference, independent t test, Chi square test and paired t-test were employed to analyze the basic attributes of the two groups and to compare the difference of effects of care before and after the both groups. The results indicated the experiment group scored was increased 3.07±2.48 in self-care knowledge, which is significantly higher than the scoring of control group (p =.03), and the tracing one month after intervention, the effect still maintained (p <.01). In daily health care behaviors, the experiment group showed increase of 12.75±10.41 after intervention, and is significantly higher than control group (p =.00).Among the items, diet （p =.00）and exercise （p =.01）showed with significant effects than control group, but in medication compliance （p =.14）and in timely return for consultation （p =.53）were no significant between two groups. In the tracing, it were found that excpet exercise time, the rest of the effects were maintained. (p <.01). The mean value of systolic and diastolic pressures dropped 10.00±14.44mmHg and 5.96±8.28mmHg in experiment group which were significantly different from control group (p =.03). The self-efficacy in diet and exercising behaviors increased 15.11±11.01 points and was significantly higher than control group (p =.00) and the effect traced one month later was still maintained (p <.01). The results supported the nurse developed disease management protocol which based on learning theory and self-efficacy promoting skill had better outcomes than regular OPD care, it may provide a reference for other hospitals in planning Chronic Disease Management program for OPD patients. Key Words: Hypertension Patient, Disease Management, Self-Care knowledge, Daily Health Care Behavior, Blood Pressure, Self –Efficacy of Health Related Behaviors.