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COLES, C. R., e B. MOUNTFORD. "Interview surveys in medical and health-care education". Medical Education 22, n.º 2 (março de 1988): 147. http://dx.doi.org/10.1111/j.1365-2923.1988.tb00425.x.
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COLES, C. R., e B. MOUNTFORD. "Interview surveys in medical and health-care education". Medical Education 22, n.º 2 (março de 1988): 148–57. http://dx.doi.org/10.1111/j.1365-2923.1988.tb00426.x.
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Wilner, Lynda Katz, e Marjorie Feinstein-Whittaker. "Improving Communication Skills in Health Care". Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse (CLD) Populations 20, n.º 3 (dezembro de 2013): 109–17. http://dx.doi.org/10.1044/cds20.3.109.
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Hospital reimbursements are linked to patient satisfaction surveys, which are directly related to interpersonal communication between provider and patient. In today’s health care environment, interactions are challenged by diversity — Limited English proficient (LEP) patients, medical interpreters, International Medical Graduate (IMG) physicians, nurses, and support staff. Accent modification training for health care professionals can improve patient satisfaction and reduce adverse events. Surveys were conducted with medical interpreters and trainers of medical interpreting programs to determine the existence and support for communication skills training, particularly accent modification, for interpreters and non-native English speaking medical professionals. Results of preliminary surveys suggest the need for these comprehensive services. 60.8% believed a heavy accent, poor diction, or a different dialect contributed to medical errors or miscommunication by a moderate to significant degree. Communication programs should also include cultural competency training to optimize patient care outcomes. Examples of strategies for training are included.
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Silverman, Thomas B., Eric W. Schrimshaw, Julie Franks, Yael Hirsch-Moverman, Hugo Ortega, Wafaa M. El-Sadr e Paul W. Colson. "Response Rates of Medical Providers to Internet Surveys Regarding Their Adoption of Preexposure Prophylaxis for HIV: Methodological Implications". Journal of the International Association of Providers of AIDS Care (JIAPAC) 17 (1 de janeiro de 2018): 232595821879837. http://dx.doi.org/10.1177/2325958218798373.
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In 2016 to 2017, we surveyed primary care providers (PCPs) in upper Manhattan and the South Bronx, New York, on their knowledge, attitudes, and practices surrounding preexposure prophylaxis (PrEP) for HIV. Despite efforts to promote survey response, we were only able to obtain a meager response rate, limiting our ability to interpret results. In this short communication, we examine our survey’s methodology, as well as the methods used by other similar studies, in order to suggest how certain strategies appear to influence PCP response to PrEP surveys. Administering the survey in a variety of modes, sampling from a professional organization’s listserv, promoting the survey topic’s relevance to potential participants, and offering monetary incentives to each survey respondent all appear to be promising strategies for increasing response rates in PrEP provider surveys.
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Hartz, Arthur, Joshua Lucas, Timothy Cramm, Michael Green, Suzanne Bentler, John Ely, Steven Wolfe e Paul James. "Physician surveys to assess customary care in medical malpractice cases". Journal of General Internal Medicine 17, n.º 7 (julho de 2002): 546–55. http://dx.doi.org/10.1046/j.1525-1497.2002.10740.x.
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Shishkina, E. A., e G. B. Kuandykov. "THE SATISFACTION WITH MEDICAL SERVICES AS AN INDICATOR OF EFFICIENCY OF FUNCTIONING OF MEDICAL INSTITUTION". Sociology of Medicine 16, n.º 2 (15 de dezembro de 2017): 122–27. http://dx.doi.org/10.18821/1728-2810-2016-16-2-122-127.
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The need in optimization of strategies of activities of various health care structures focuses scientific practical interest to studying a degree of satisfaction of patients with not only received medical care but psychological interactions with specialists, sanitary hygienic, organizational, sociocultural and other characteristics of curative institution. The purpose of study is targeted to corroborate a hypothesis about expediency of involvement of sociological surveys to medical care quality assessment in conditions of practical health care institutions. The article designates theoretical foundation of the problem and expounds results of applied study (questionnaire survey) targeted to evaluate competence and level of professionalism of specialists, benevolence of employees, diagnostic possibilities, sanitary hygienic conditions and also preventive, informational and organizational functioning of institution. On the basis of gender and age-related criteria differences in indices of requirements of respondents were established and their common needs in sphere of supporting physical and social health as well.
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Tatematsu, Satoru, Kazuo Kobayashi, Yasunori Utsunomiya, Tsuguru Hatta, Taisuke Isozaki, Masanobu Miyazaki, Yosuke Nakayama, Takuo Kusumoto, Nobuo Hatori e Haruhisa Otani. "Comparison of the 2013 and 2019 Nationwide Surveys on the Management of Chronic Kidney Disease by General Practitioners in Japan". Journal of Clinical Medicine 11, n.º 16 (16 de agosto de 2022): 4779. http://dx.doi.org/10.3390/jcm11164779.
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In 2019, the Japan Physicians Association conducted a second nationwide survey on the management of chronic kidney disease (CKD) among the Japanese general practitioners (GPs). We aimed to clarify the changes in the state of CKD medical care by GPs since the 2013 survey. The 2013 and 2019 surveys included 2214 and 601 GPs, respectively, who voluntarily participated. The two surveys were compared, using propensity score matching to balance the background of the responded GPs. For the medical care of CKD, the frequency of urine or blood examination, use of estimated glomerular filtration rate (eGFR) value for CKD management, and continuous use of renin-angiotensin system inhibitors for their reno-protective effects were significantly higher in 2019 than in 2013 (all: p < 0.001). The medical cooperation in CKD management, the utilization of the clinical path for CKD management and the measurement of the eGFR during the medical health checkup were significantly increased in 2019, compared to those in 2013. More GPs felt dissatisfied with the components of CKD treatment by nephrologists (p < 0.001). The two surveys confirmed improvements in the level of medical care for CKD and a strengthening in cooperation. However, the dissatisfaction with the consultation with nephrologists did not necessarily improve.
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Udawatta, Methma, Yasmine Alkhalid, Thien Nguyen, Vera Ong, Jos’lyn Woodard, John P. Sheppard, Courtney Duong et al. "Patient Satisfaction Ratings of Male and Female Residents Across Subspecialties". Neurosurgery 86, n.º 5 (20 de agosto de 2019): 697–704. http://dx.doi.org/10.1093/neuros/nyz281.
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Abstract BACKGROUND Females currently comprise approximately 50% of incoming medical students yet continue to be underrepresented in certain medical subspecialties. OBJECTIVE To assess whether gender plays a role in patients’ perception of physician competency among different specialties. METHODS We administered surveys at 2 academic medical centers to patients who were stable, cognitively aware, and indicated English as their primary language. Survey questions evaluated communication, medical expertise, and quality of care. RESULTS A total of 4222 surveys were collected. Females comprised around half (n = 2133, 50.7%) of evaluated residents. First-year (n = 1647, 39%) and second-year (n = 1416, 33.5%) residents were assessed most frequently. Internal medicine conducted the most surveys (n = 1111, 23.6%), whereas head and neck surgery conducted the least (n = 137, 3.24%). There was no statistically significant difference between patients’ perception of male and female residents of the same year in overall communication skills, medical expertise, and quality of medical care. Female residents outperformed their male counterparts on specific questions evaluating the communication of treatment plans, patient education, and patient satisfaction (P < .001, P = .03, P = .04, respectively). Unsurprisingly, patients’ perceptions of residents’ overall communication skills, medical expertise, and quality of medical care significantly improved when comparing more experienced residents to newer residents. CONCLUSION There is no difference between overall communication, medical expertise, and quality of care between sexes, and across subspecialties. Though gender inequalities currently exist most starkly in practitioners in surgical subspecialties, women in surgical residencies were much better communicators than their male counterparts, but still perceived to have similar levels of medical expertise and quality of care.
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Ossowski, Stephanie, Amy Kammerer, Douglas Stram, Lisa Piazza-DeLap, Ethan Basch e Jed A. Katzel. "Patient-Reported Outcomes Integrated Within an Electronic Medical Record in Patients With Head and Neck Cancer". JCO Clinical Cancer Informatics, n.º 5 (agosto de 2021): 842–48. http://dx.doi.org/10.1200/cci.21.00058.
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PURPOSE Patient-reported outcome (PRO) tools lead to clinical benefits, including improved overall survival for patients with cancer. However, routine implementation of PROs in clinical practice within the electronic medical record (EMR) by integrated health care delivery systems remains limited. We studied the use of a PRO tool for patients with head and neck cancer (HNC) integrated in an EMR at Kaiser Permanente in Northern California. METHODS Between August 2017 and December 2019, patients with newly diagnosed HNC were surveyed at baseline, then every 3 months using the Functional Assessment of Cancer Therapy–General 7 and Functional Assessment of Cancer Therapy–Head and Neck (version 4). A medical assistant performed a baseline survey on diagnosis and then notified patients electronically per surveillance protocol. Patients who did not respond to online PRO surveys could complete them via telephone or in-person appointments with medical assistants. Abnormal findings on PRO surveys were referred to appropriate members of the care team or the treating Otolaryngology-Head and Neck Surgery physicians. RESULTS Two hundred ninety patients received baseline surveys. Patients received up to a maximum of eight subsequent surveys. Of a total of 597 electronic surveys, 585 (97.9%) were completed. The percentage of patients completing each interval survey ranged from 92% to 100%. Multivariate Poisson regression analysis showed patients with English as their primary language and an online secure account were the most likely to complete surveys compared with those patients with non-English as a primary language and without an online account. CONCLUSION PRO tools can be effectively used within the EMR for patients with HNC with a high response rate provided there is strong engagement from a dedicated member of the care team. This has important implications for designing clinical trials and symptom monitoring in clinical practices that incorporate EMRs.
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Russell, Roberta S., Dana M. Johnson e Sheneeta W. White. "Patient perceptions of quality: analyzing patient satisfaction surveys". International Journal of Operations & Production Management 35, n.º 8 (3 de agosto de 2015): 1158–81. http://dx.doi.org/10.1108/ijopm-02-2014-0074.
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Purpose – Healthcare facilities are entering an era of increased oversight and heightened expectations concerning both reduced costs and measureable quality. The US Affordable Care Act requires healthcare organizations to collect certain metrics, including patient assessments of quality, in order to monitor and improve the quality of healthcare. These metrics are used as a basis for graduated insurance reimbursements, and are available to consumers as an aid in selecting healthcare providers and insurance plans. The purpose of this paper is to provide healthcare providers with the analytic capabilities to better understand quality of care from the patient’s point of view. Design/methodology/approach – This research examines patient satisfaction data from a multi-specialty Medical Practice Group, and uses regression analysis and paired comparisons to provide insight into patient perceptions of care quality. Findings – Results show that variables related to Access, Moving Through the Visit, Nurse/Assistant, Care Provider and Personal Issues significantly impact overall assessments of care quality. In addition, while gender and type of care provider do not appear to have an impact on overall patient satisfaction, significant differences do exist based on age group, specialty of the physician and clinic type. Originality/value – This study differs from most academic research as it focusses on medical practices, rather than hospitals, and includes multiple clinic types, medical specialties and physician types in the analysis. The study demonstrates how analytics and patient perceptions of quality can inform policy decisions.
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Marshall, Ric, David Grayson, Anthony Jorm e Brian O'Toole. "Are survey measures of medical careutilisation misleading?" Australian Health Review 24, n.º 3 (2001): 91. http://dx.doi.org/10.1071/ah010091.
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found when estimates from self-report data from anepidemiolgical study were compared to actual cost data extracted from administrative records. Even though the fewsubjects who were actually provided with two or more services in the two-week self-report period substantially under-reportedtheir medical care consumption, a large net over-estimate of medical care consumption was produced by theself-report data. This finding has important implications for use of self-report data from surveys such as the AustralianBureau of Statistics (ABS) National Health Survey for estimating health service consumption.By combining epidemiological survey data from the Australian Vietnam Veterans Health Study (AVVHS), with dataon actual medical care for which the Health Insurance Commission (HIC) or the Department of Veterans' Affairs (DVA)paid benefits, we were able to directly compare self-reported medical care consumption with actual medical careutilisation. The comparison revealed that veterans' self-reports were a valid measure of relative medical careconsumption because those who reported care over the past two weeks were much more likely to have been recentconsumers than those who did not. This relationship became even stronger if the comparison of self-report was extendedto data on benefits paid beyond the two-week self-report period. However, the HIC and DVA data confirmed only 51%of veterans self-reporting medical care consumption during the past two weeks actually received a service.
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Ossowski, Stephanie, Amy Kammerer, Ethan M. Basch e Jed Abraham Katzel. "Patient-reported outcomes integrated within electronic medical record in patients with head and neck cancer." Journal of Clinical Oncology 38, n.º 15_suppl (20 de maio de 2020): e14026-e14026. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e14026.
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e14026 Background: Patient-reported outcome (PRO) tools have been shown to improve outcomes including overall survival for cancer patients. However, routine implementation of PROs in clinical practice within the electronic medical record (EMR) remains limited. We studied the use of a PRO tool for patients with head and neck cancer (HNC) integrated in an EMR. Methods: Between August 2017 and December 2019 patients with newly diagnosed HNC were surveyed at baseline, then every 3 months using the FACT-G7 and FACT H&N (Version 4). A medical assistant (MA) performed a baseline survey around the time of diagnosis and then notified patients electronically every 3 months for two years and then every 6 months until patients completed their 5 years of surveillance. Patients who did not respond to online PRO surveys could complete them via telephone appointments with MAs, or in office pre-rooming. Abnormal findings on PRO surveys were referred to appropriate members of the care team or the treating ENT physicians. Results: 290 patients received baseline surveys. Patients received up to a maximum of 8 subsequent surveys (table). Out of a total of 597 electronic surveys, 585 (97.9%) were completed. The percentage of patient completing each survey ranged from 92-100%. Conclusions: PRO tools can be effectively deployed within the EMR for HNC patients with a high completion rate provided that there is strong engagement from a dedicated member of the care team. This has important implications for designing clinical trials and symptom monitoring in clinical practices that incorporate EMRs.
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Haine, James Edward, Elizabeth R. Trowbridge, Sandra A. Kamnetz, David Feldstein, Lee G. Wilke, James Sosman, SarahMaria Hill Donohue, Mary E. Sesto e Amye Tevaarwerk. "A primary care education program regarding cancer survivorship care plans at the University of Wisconsin (UW)." Journal of Clinical Oncology 35, n.º 5_suppl (10 de fevereiro de 2017): 69. http://dx.doi.org/10.1200/jco.2017.35.5_suppl.69.
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69 Background: Survivorship care plans (SCPs) have been recommended as a tool to improve cancer patients’ (pts) care coordination and outcomes. The UW routinely provides SCPs. However, a prior project indicated most PCPs were unaware of these SCPs, limiting SCPs potential benefits. Best methods for educating PCPs regarding SCP existence and content are needed. We developed an educational program to inform PCPs of SCP existence, content, and potential uses. Methods: The program - a 10 minute presentation with slides - was developed to make PCPs aware of the basics of SCPs as listed above. The program was presented at UW general internal medicine (GIM) and family medicine (FM) scheduled meetings and emailed to UW PCPs afterwards. Two anonymous online surveys were administered to evaluate PCP previous use and basic knowledge of SCPs. Baseline surveys were sent 1 week prior to the first presentation and a follow-up survey was sent 4 weeks later via UW GIM and FM listservs (n = 286 addresses). Results: 101 PCPs completed the baseline survey: 27% reported not knowing what SCPs were; 50% knew but reported never receiving one; 23% reported having received one. 66 PCPs that attended or reviewed the program completed the follow-up survey. 40 “matched” PCPs completed both surveys. See Table 1 for results. Conclusions: A brief educational program containing information about existence of, content, and location in electronic medical record (EMR) increased PCP knowledge in these areas, which are prerequisites for PCP use. Ongoing work will assess whether PCP review of SCPs at point of care influences clinical decision making. [Table: see text]
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Aguilera, Antonio M., David L. Wood, Cortney Keeley, Hector E. James e Philipp R. Aldana. "Young adults with spina bifida transitioned to a medical home: a survey of medical care in Jacksonville, Florida". Journal of Neurosurgery: Pediatrics 17, n.º 2 (fevereiro de 2016): 203–7. http://dx.doi.org/10.3171/2015.7.peds14694.
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OBJECT The transition of the young adult with spina bifida (YASB) from pediatric to adult health care is considered a priority by organized pediatrics. There is a paucity of transition programs and related studies. Jacksonville Health and Transition Services (JaxHATS) is one such transition program in Jacksonville, Florida. This study’s purpose was to evaluate the health care access, utilization, and quality of life (QOL) of a group of YASBs who have transitioned from pediatric care. METHODS A survey tool addressing access to health care and quality of health and life was developed based on an established survey. Records of the Spinal Defects Clinic held at Wolfson Children’s Hospital and JaxHATS Clinic were reviewed and YASBs (> 18 and < 30 years old) were identified. RESULTS Ten of the 12 invited YASBs in the Jacksonville area completed the surveys. The mean age of respondents was 25.1 years. All reported regular medical home visits, 8 with JaxHATS and 2 with other family care groups. All reported easy access to medical care and routine visits to spina bifida (SB) specialists; none reported difficulty or delays in obtaining health care. Only 2 patients required emergent care in the last year for an SB-related medical problem. Seven respondents reported very good to excellent QOL. Family, lifestyle, and environmental factors were also examined. CONCLUSIONS In this small group of YASBs with a medical home, easy access to care for medical conditions was the norm, with few individuals having recent emergency visits and almost all reporting at least a good overall QOL. Larger studies of YASBs are needed to evaluate the positive effects of medical homes on health and QOL in this population.
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Stoeckle, John D., e Sherman Eisenthal. "Medical Residents Evaluate Their Medical School Training in Psychosocial Care". Psychological Reports 82, n.º 3_suppl (junho de 1998): 1375–86. http://dx.doi.org/10.2466/pr0.1998.82.3c.1375.
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A questionnaire was sent to all 77 general medical residents at one teaching hospital (18 primary care and 59 the traditional program), to investigate retrospectively their psychosocial training in medical school. 62 complete surveys (81%) were returned. The training was rated good by 62% of the residents and important for psychosocial practice by 45%. In ambulatory settings, supervisors were rated as supporting the doctor-patient relationship (79%) and spending time on psychosocial problems (65%). In inpatient settings, spending time on psychosocial problems was not widely supported (36%). Training to interview was rated far from optimal by 49% of the residents. Psychosocial attitudes in residency did not have substantial correlations with training. In the choice of residency program, what distinguished residents in primary care from those in the traditional program was the positive ratings given their supervisors' psychosocial orientation, but not the supervisors' nor the residents' psychosocial competency or weeks spent in training. In sum, the two most potent influences on psychosocial orientation appear to be positive role models and the clinical setting.
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Dalia, Samir, e Fred J. Schiffman. "Who's My Doctor? First-Year Residents and Patient Care: Hospitalized Patients' Perception of Their “Main Physician”". Journal of Graduate Medical Education 2, n.º 2 (1 de junho de 2010): 201–5. http://dx.doi.org/10.4300/jgme-d-09-00082.1.
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Abstract Background Studies have shown that a large portion of patient satisfaction is related to physician care, especially when the patient can identify the role of the physician on the team. Because patients encounter multiple physicians in teaching hospitals, it is often difficult to determine who the patient feels is his or her main caregiver. Surveys evaluating resident physicians would help to improve patient satisfaction but are not currently implemented at most medical institutions. Intervention We created a survey to judge patient satisfaction and to determine who patients believe is their “main physician” on the teaching service. Methods Patients on a medical teaching service at The Miriam Hospital during 20 days in March 2008 were asked to complete the survey. A physician involved in the research project administered the surveys. Surveys included 3 questions that judged patient's perception and identification of their primary physician and 7 questions regarding patient satisfaction. Completed surveys were analyzed using averages. Results Of the 126 patients identified for participation, 102 (81%) completed the survey. Most patients identified the intern (first-year resident) as their main physician. Overall, more than 90% of patients expressed satisfaction with their main physician. Conclusion Most patients on the teaching service perceived the intern as their main physician and were satisfied with their physician's care. One likely reason is that interns spend the greatest amount of time with patients on the teaching service.
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Tewari, Krishnansu, Ralph Steiger, Bradley Monk, Gianna Scannell, Gail Tominaga e Kenneth Waxman. "Should Critical Care Medicine be a Formal Part of the Undergraduate Curriculum?" Journal of Intensive Care Medicine 11, n.º 1 (janeiro de 1996): 13–18. http://dx.doi.org/10.1177/088506669601100103.
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Medical students were surveyed shortly after completing the third year of medical school. The survey was designed to identify those areas of critical care medicine students had been exposed to and expressed interest in learning more about. In addition, the surveys sought to discern the level of confidence students felt with respect to different critical illnesses and intensive care unit (ICU) therapeutic modalities. Finally, the students were asked their opinion regarding the possibility or need for critical care medicine as part of their medical school curriculum. The three most common topics of interest among medical students who had recently finished their third year in medical school were shock, hemodynamic monitoring, and mechanical ventilation. Less than 30% of the students surveyed felt “better-than-average” confidence on any one of a number of critical care topics and treatment modalities. Of the 80% of students (n = 70) who completed the survey, 91% (n = 64) felt that critical care medicine should be made a part of the medical school curriculum, 6% (n = 4) felt it should not, and 3% (n = 2) were undecided. The survey results and the finding that most of the relevant literature acknowledges the need for critical care medicine in medical school has led us to conclude that a national core clerkship or a didactic lecture series in critical care medicine should be carefully designed and implemented into the undergraduate curriculum.
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Moye, Jennifer, Hannah Bashian, Hannah Heintz, Jennifer Daks, Lola Baird, Anica Pless Kaiser, Kelly O'Malley e Anna Etchin. "ADDRESSING TRAUMA IN OLDER VETERANS IN HOME-BASED PRIMARY CARE". Innovation in Aging 6, Supplement_1 (1 de novembro de 2022): 150–51. http://dx.doi.org/10.1093/geroni/igac059.601.
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Abstract As Veterans age, confronting illness and role changes, they may experience later adulthood trauma reengagement (LATR). To better understand this process in medically ill Veterans, we completed six focus groups with 21 VA Home Based Primary Care (HBPC) mental health clinicians in rural and urban settings; 14 completed a follow-up survey. Thematic analysis of focus groups confirmed the LATR model with unique presentation and treatment challenges related to medical, physical, and cognitive changes. In surveys, the most challenging symptoms were: intrusive symptoms, dissociative reactions, and psychological/physiological reactivity (79%). In addition to focus group themes, surveys described challenges related limited social engagement, Veteran ambivalence, and lack of empirically supported treatments appropriate to HBPC. Results of these focus group and survey data provide key insights into the unique presentation of trauma in aging medically ill Veterans. Ongoing efforts to adapt materials and resources for this population will be described.
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Su, Yingying, Junfang Teng, Suyue Pan, Wen Jiang, Furong Wang, Fei Tian, Jing Jing et al. "The development of the neurocritical care specialty in China based on the analysis of neurocritical care unit volume and quality". Brain Circulation 10, n.º 1 (2024): 67–76. http://dx.doi.org/10.4103/bc.bc_71_23.
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Abstract: PURPOSE: Through three neurocritical care unit (NCCU) surveys in China, we tried to understand the development status of neurocritical care and clarify its future development. METHODS: Using a cross-sectional survey method and self-report questionnaires, the number and quality of NCCUs were investigated through three steps: administering the questionnaire, sorting the survey data, and analyzing the survey data. RESULTS: At the second and third surveys, the number of NCCUs (76/112/206) increased by 47% and 84%, respectively. The NCCUs were located in tertiary grade A hospitals or teaching hospitals (65/100/181) in most provinces (24/28/29). The numbers of full-time doctors (359/668/1337) and full-time nurses (904/1623/207) in the NCCUs increased, but the doctor–bed ratio and nurse–bed ratio were still insufficient (0.4:1 and 1.3:1). CONCLUSION: In the past 20 years, the growth rate of NCCUs in China has accelerated, while the allocation of medical staff has been insufficient. Although most NCCU hospital bed facilities and instruments and equipment tend to be adequate, there are obvious defects in some aspects of NCCUs.
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Slehria, Atiq Ur Rehman. "Role of Patient Feedback in Better Medical Care". Pakistan Armed Forces Medical Journal 73, n.º 2 (14 de abril de 2023): 318–20. http://dx.doi.org/10.51253/pafmj.v73i2.10239.
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Patient satisfaction and experience are important indicators for measuring healthcare quality. The recent widespread use of patientexperience surveys in healthcare settings is based on the fact that feedback has a potentially important role in improving the quality of care, affects clinical outcomes and timely, efficient, patient-centred delivery of quality health. Research into patient experience feedback is a relatively recent phenomenon that began in the 1990s.1 Research into how healthcare providers use this data to improve services is at an early stage. Recent systematic research on patient experience and feedback collection was held at the Armed Forces Institute of Radiology & Imaging (AFIRI), providing evidence to influence debate, policy and practice on patient feedback data.
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Chan, E. Y. Y., P. P. Y. Lee e J. M. S. Leung. "(P1-85) Health Seeking Behavior Post-Unintentional Household Injury in Hong Kong". Prehospital and Disaster Medicine 26, S1 (maio de 2011): s126. http://dx.doi.org/10.1017/s1049023x11004171.
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BackgroundUnintentional household injuries are a major public health problem that affects large numbers of people. Various population-based surveys from the literature showed > 40% of households reporting an injury that required medical attention. However, there is a general lack in comprehensive population surveys to highlight the risk of post-injury, help-seeking behavior and its associated financial cost. This study is part of the urban, home-based injury epidemiological study series (2007–2010) in Hong Kong.MethodsA population-based, cross-sectional, random telephone survey was conducted using the last birthday method in 2009. A study instrument was developed and validated based on the modified Chinese World Health Organization guidelines for injury and violence surveys.ResultsThe study population comprised of non-institutionalized, Cantonese-speaking Hong Kong residents (n = 6,570). Among the 39.4% self-reported injuries within the past 12 months, only 8.6% of injured people had sought medical care. Respondents tended to seek medical care from the private setting in the first episode of post-injury treatment. Among health seekers, 70% of the injured participants reported having to seek a second treatment and the care-seeking pattern shifted from private to public medical service delivery setting. Predictors of service preferences were identified and discussed.ConclusionsMedical care seeking patterns post-unintentional household injury was identified. Medical and emergency services providers may wish to consider health service implications.
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Bontsevich, Roman, Yulia Kirienko, Viktoriya Bogatova, Elena Milutina, Vladimir Kovalenko, Aleksandra A. Melnichenko, Galina Batishcheva, Natalia Goncharova e Andrey Agapov. "Assessment of senior medical care majors’ knowledge in antimicrobial chemotherapy". Research Results in Pharmacology 4, n.º 4 (18 de dezembro de 2018): 107–13. http://dx.doi.org/10.3897/rrpharmacology.4.31960.
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Introduction: The resistance of microorganisms to antimicrobials has been gradually increasing since 2011 and is now recognized by the World Health Organization as a global biological threat. Causes of antimicrobial resistance must be actively addressed. Healthcare workers’ awareness of rational antimicrobial prescribing practices is of great importance. The increasing relevance of this issue is considered within this study, which started in 2014. Materials and methods: The article represents the results of anonymous prospective surveys within the framework of the KANT multi-centered research project aimed at assessing students’ knowledge of rational antimicrobial prescribing practices also known as “antimicrobial stewardship”. The survey involved 309 Medical Care majors in their fifth- and sixth- years in two Russian regional centers: Belgorod and Voronezh. The answers to four main questions of the survey were analyzed in this work. Results and discussion: According to the survey, 51.5% of the respondents properly identified a pharmacological group of an antimicrobial; 79.3% of the students would change an antibiotic if the desired therapeutic outcome was not achieved within two or three days of treatment; 29.8% of the students believed that an antimicrobial substitution was required even when a positive therapeutic outcome was achieved; and nobody could correctly identify all the proposed pharmacologically irrational combinations of antimicrobials. Conclusions: The survey showed that senior medical students have insufficient knowledge in antimicrobial stewardship. Appropriate use of antibiotics and antimicrobial prescribing practices need to be considered more thoroughly in Pharmacology, Clinical Pharmacology and Medical Care curricula. Likewise, educational activities on antimicrobial stewardship and best prescribing practices are of great importance for students as they will help with improving the knowledge of future doctors.
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Stepanyan, Katelyn D., Timothy E. Weiss, Antonio M. Pessegueiro e Christopher J. Pietras. "Lessons From the Development and Implementation of a Palliative Care Elective for Fourth-Year Medical Students: A Pilot Study". American Journal of Hospice and Palliative Medicine® 37, n.º 3 (2 de setembro de 2019): 191–95. http://dx.doi.org/10.1177/1049909119872976.
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Background: Although palliative care is recognized as an important component of medical school curricula, the content and structure of education in the field is variable and often lacks outpatient exposure. We aimed to develop and implement a palliative care clinical elective for fourth-year medical students incorporating both inpatient and outpatient learning. Methods: Fourteen medical students participated in a palliative care elective which included 2 weeks on an inpatient consult service and 1 week of outpatient clinic and home hospice visits. The elective was evaluated using a focus group and previously validated surveys assessing self-rated competency and attitudes toward caring for palliative care patients. Data were analyzed using paired t tests to compare survey response means before and after the elective. Results: Of the 14 participating students, 7 completed both the pre- and postelective surveys. Significant improvements in self-rated competency were seen in pain and symptom management ( P < .001), communication ( P < .001), and advance care planning ( P < .01). Survey results also showed improvement in attitudes toward caring for dying patients ( P < .001), with lower scores at the end of the elective suggesting reduced emotional distress. Although the outpatient component was hypothesized to be a major benefit of the curriculum, qualitative data revealed the most highly valued component to be direct observation and feedback during inpatient time. Conclusion: Given the highlighted importance of direct observation and feedback as a unique and powerful learning experience, future work should be targeted toward enhancing the quality and timeliness of feedback delivered by the palliative care interdisciplinary team.
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Hermann, Emilia A., Jeffrey M. Ashburner, Steven J. Atlas, Yuchiao Chang e Sanja Percac-Lima. "Satisfaction With Health Care Among Patients Navigated for Preventive Cancer Screening". Journal of Patient Experience 5, n.º 3 (17 de janeiro de 2018): 225–30. http://dx.doi.org/10.1177/2374373517750413.
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Background: Patient navigation (PN) programs can improve cancer screening in underserved populations. PN may advance quality and equity of care by supporting individuals at increased risk of not receiving recommended care. Objective: To evaluate patient satisfaction with medical care and PN for cancer screening. Methods: We conducted a telephone survey of patients enrolled in a randomized control trial evaluating the impact of PN for cancer screening to assess their satisfaction with overall medical care and the PN program. We measured patient satisfaction with medical care using the Patient Satisfaction Questionnaire-18 and evaluated patient satisfaction with PN in the navigated group using the Patient Satisfaction with Interpersonal Relationships with Navigator questionnaire. Key Results: Satisfaction surveys were completed by 114 navigated and 108 non-navigated patients (33% response rate). Patients who received PN had higher satisfaction scores with overall medical care (71.0 vs 66.8; P < .001). Conclusions: Our findings show that patients at high risk of nonadherence with comprehensive cancer screening were satisfied with PN and suggest that PN could positively influence patient satisfaction with overall medical care.
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Hansen, Natasha, Susan Youll, Lia Florey e Cameron Taylor. "Intermittent Preventive Treatment of Malaria in Pregnancy Coverage Estimates from Population-based Surveys: Reliability of Women's Recall Among Women with ANC Cards". American Journal of Tropical Medicine and Hygiene 105, n.º 2 (11 de agosto de 2021): 472–76. http://dx.doi.org/10.4269/ajtmh.20-1296.
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ABSTRACT. Large household surveys performed to estimate coverage rates for various health interventions, including intermittent preventive treatment, depend on recall. Many studies question the validity of recalled data. Regarding vaccine coverage rates, it is standard practice to validate responses using medical history cards. To validate the coverage rates of intermittent preventive treatment during pregnancy reported by large household surveys, recalled coverage rates were compared with antenatal care card data in Benin, Ghana, Malawi, and Tanzania. The results indicated that recall was comparable to the coverage rates provided indicated by the antenatal care cards. These findings suggest that intermittent preventive treatment coverage rates reported by large household surveys performed using recalled data are valid.
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Lafontaine, Audrey, Hema Patel e Isabelle St-Sauveur. "100 Just how long does it take? Using parental surveys documenting time required to provide care at home to children with medical complexity as a tool for advocacy". Paediatrics & Child Health 25, Supplement_2 (agosto de 2020): e41-e42. http://dx.doi.org/10.1093/pch/pxaa068.099.
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Abstract Background Children with medical complexity (CMC) constitute a growing population here and everywhere. CMC are fragile, complex, and dependent on technology. Sustainable, safe and effective care at home requires a high level of parental dedication, in knowledge, skills and time. While children thrive in the home setting, the demands on caregivers are substantial. As part of a larger advocacy project, a collaboration between healthcare professionals looking after CMC in Quebec was formed with a primary goal to create evidence-based standardized guidelines for homecare practices. During this process, wide disparities in actual care support received were noted as was the paucity of publication quantifying the time it takes to care for CMC at home. This innovative survey was planned to better describe families’ experiences and to further advocacy efforts with the development of data-driven care support recommendations. Objectives The objectives of this prospective survey were: a) to quantify daily parental expenditure of time to provide care at home to their child requiring i) parenteral nutrition (TPN), ii) peritoneal dialysis (PD), iii) noninvasive ventilation (BIPAP) or iv) tracheostomy care (TC) and b) to qualitatively explore the perceptions of parents regarding existing and desired homecare supports. Design/Methods Quebec CMC were identified through collaboration of multidisciplinary experts from each pediatric university hospital center and the provincial home ventilation program. The daily care required for CMC was described step-by-step with input from CMC’s parents with either TPN, PD, BIPAP or TC. A survey was developed to estimate time required by parents for care completion related to technology, medication, enteral feeding, maintenance of equipment and care organization. Open ended questions on parental perceptions of existing and desired homecare supports were included. The surveys were sent to all eligible families by their primary pediatrician or nurse. Data were entered into a database. For each care intervention, descriptive analyses were performed to determine the median (interquartile range) time required. Thematic analyses were used to evaluate open ended responses. Summary data was used by the expert collaboration to draft data-driven homecare support recommendations for CMC in Quebec and create request template to translate the recommendations into a practical tool for advocacy. Results A total of 87 parents of CMC were surveyed and 78 with complete quantitative data were available for analysis. For TPN, 14 surveys were available. The median (interquartile range) of total daily time dedicated to medical care was 259 (180) minutes a day, with care distributed through TPN administration and preparation (62 (49) minutes/day), enteral nutrition when indicated (42 (34) minutes/day), medication (48 (70) minutes/day) and meal (135(98) minutes/day). For PD, 12 surveys were available. Total daily time dedicated to medical care was 160 (111) minutes/day, with care distributed through dialysis administration and preparation (58 (19) minutes/day), enteral nutrition when indicated (35 (25) minutes/day), medication (35 (28) minutes/day) and other medical care (46 (24) minutes/day). For BIPAP, 39 surveys were available. Total daily time dedicated to care directly associated with BIPAP use was 18 (15) minutes/day. Total daily time dedicated to medical care was 55 (77) minutes/day when well, and 83 (180) minutes/day when sick. Respiratory care was 31 (42) minutes/day when well, and 48 (125) minutes/day when sick. Medication administration was 20 (22) minutes/day when well and 28 (60) minutes/day when sick. Personnel and equipment management was reported to take a median of 55 (interquartile range 119) minutes/week. For TC, 13 surveys were available. Total daily time dedicated to medical care was 109 (239) minutes/day, with 87 (111) minutes/days of direct tracheostomy care. Parents of CMC asked for further support in those categories: financial help, help with home task, respite, nighttime help and specialized support. Conclusion Parents provide substantial care at home for CMC. This study provides a first look at the actual time required to perform care. Although widely distributed, those time data give a first and unique overview of the task for parents taking care of CMC. Data driven recommendations for care support at home were created, along with standardized care request templates which are now in regular use in Quebec, demonstrating a powerful tool for advocacy.
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Rostami, Sohayla, Qingwen Kawaji, Stephanie L. Martinez, Tomer Lagziel, Rowena Orosco, Carolina J. Flores, Charles S. Hultman e Julie Caffrey. "585 Focused Wound Care Handoff Improves Burn Center Physician-Nursing Communication and Wound Care Education". Journal of Burn Care & Research 43, Supplement_1 (23 de março de 2022): S129—S130. http://dx.doi.org/10.1093/jbcr/irac012.213.
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Abstract Introduction Burn patients often require changing wound care routines dependent on wound characteristic and operative interventions. Unfortunately, order discrepancies on electronic medical systems, poor communication between providers, nursing, and wound care technicians leads to incorrect wound care treatment. By creating a daily dedicated wound care discussion involving integral components of the wound care team (provider, charge nurse, and wound care technicians), we hope to improve communication amongst team members and provide wound care education at all levels. Methods The study was carried out at a single-center burn unit. A pre-intervention, de-identified survey was distributed to the nursing staff to determine familiarity with wound care as well as assessment of communication regarding wound care in the burn unit. A planned intervention was then initiated for a period of four weeks. Daily, timed dedicated wound care rounds were carried out. The wound plan was then reflected on a personalized diagram for each patient, on electronic medical records and updated on resident/fellow notes. Nursing staff satisfaction and assessment of communication was completed again using a post-intervention, de-identified survey. Results Initial data from our planned four-week intervention showed that on average, we round on 7.9 patients on burn wound unit, 4 patients on intermediate care unit (IMC), and 2.9 patients on intensive care unit daily. During wound care handoff, we discussed 12.5 patients daily with an average time of 51 seconds per patient. When wound care routines are added to morning rounds, we spend 50 seconds per each burn wound unit patient, 120.5 seconds per each IMC patient and 735 seconds per each ICU patient. There was a total of 19 surveys collected prior to intervention. Four of the 19 surveys were filled by burn wound floor nurses and 15 were filled by ICU nurses. On average, nursing reported their wound care proficiency to be 4 out of 5 (5 being the highest score). Majority reported spending about 1-3 hours per shift on wound care (58%). Most nurses review wound care routine on nursing handoff (66%), resident/fellow notes (22%) and electronic medical record orders (11%). Mid-intervention satisfaction survey showed that most nurses felt that communication was improved, discrepancies between staff members were minimized, and that 100% of nurses wanted this intervention to be continued. Conclusions Adverse wound care events can happen despite nursing self-reported high level of wound care proficiency. To ensure accurate plan of care, wound care routine needs to be communicated at multiple levels: during rounds, in daily progress notes, and on electronic medical record orders.
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Yuan, Christina M., Dustin J. Little, Eric S. Marks, Maura A. Watson, Rajeev Raghavan e Robert Nee. "The Electronic Medical Record and Nephrology Fellowship Education in the United States". Clinical Journal of the American Society of Nephrology 15, n.º 7 (23 de junho de 2020): 949–56. http://dx.doi.org/10.2215/cjn.14191119.
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Background and objectivesAn unintended consequence of electronic medical record use in the United States is the potential effect on graduate physician training. We assessed educational burdens and benefits of electronic medical record use on United States nephrology fellows by means of a survey.Design, setting, participants, & measurementsWe used an anonymous online opinion survey of all United States nephrology program directors (n=148), their faculty, and fellows. Program directors forwarded survey links to fellows and clinical faculty, indicating to how many they forwarded the link. The three surveys had parallel questions to permit comparisons.ResultsTwenty-two percent of program directors (n=33) forwarded surveys to faculty (n=387) and fellows (n=216; 26% of United States nephrology fellows). Faculty and fellow response rates were 25% and 33%, respectively; 51% of fellows agreed/strongly agreed that the electronic medical record contributed positively to their education. Perceived positive effects included access flexibility and ease of obtaining laboratory/radiology results. Negative effects included copy-forward errors and excessive, irrelevant documentation. Electronic medical record function was reported to be slow, disrupted, or completely lost monthly or more by >40%, and these were significantly less likely to agree that the electronic medical record contributed positively to their education. Electronic medical record completion time demands contributed to fellow reluctance to do procedures (52%), participate in conferences (57%), prolong patient interactions (74%), and do patient-directed reading (55%). Sixty-five percent of fellows reported often/sometimes exceeding work-hours limits due to documentation time demands; 85% of faculty reported often/sometimes observing copy-forward errors. Limitations include potential nonresponse and social desirability bias.ConclusionsRespondents reported that the electronic medical record enhances fellow education with efficient and geographically flexible patient data access, but the time demands of data and order entry reduce engagement in educational activities, contribute to work-hours violations, and diminish direct patient interactions.
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Baker, G. Ross, Hannah King, Jeanne L. MacDonald e Jeffrey D. Horbar. "Using Organizational Assessment Surveys for Improvement in Neonatal Intensive Care". Pediatrics 111, Supplement_E1 (1 de abril de 2003): e419-e425. http://dx.doi.org/10.1542/peds.111.se1.e419.
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Background. Problems with organizational culture, lack of or poor team communications, and conflict are often seen as barriers to improvement efforts. Methods. A survey measuring aspects of organizational culture was administered twice to staff in neonatal intensive care units participating in the Neonatal Intensive Care Unit Quality Improvement Collaborative Year 2000 collaborative. The surveys provided comparative data on coordination, teamwork and leadership, conflict management, unit leadership and unit culture. These data were summarized and fed back to NICU teams with guidance on their use. Interviews on the use of the survey were held with 12 medical directors and patient care leaders in 9 different NICUs. Results. The findings indicated that all the units contacted saw themselves as committed to undertaking the organizational survey and using the results. Some units shared the data widely and initiated changes. Other units limited the distribution of data to the unit leadership. There was no apparent relationship between scores on the survey and activities undertaken. Several respondents credited the survey with helping to promote discussions about organizational and team issues. Conclusions. Future use of the survey should include additional materials to assist in disseminating the results to staff.
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Falkenstein, Lina, Nathalie Eckel, Simone B. Kadel, Jochem Koenig, David Litaker e Michael Eichinger. "Service provision and utilisation in German paediatric primary care practices during public health crises: Protocol of the mixed-methods COVID-19 PedCare Study". BMJ Open 12, n.º 10 (outubro de 2022): e054054. http://dx.doi.org/10.1136/bmjopen-2021-054054.
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IntroductionPublic health crises such as pandemics can cause serious disruptions to the utilisation and provision of healthcare services with negative effects on morbidity and mortality. Despite the important role of paediatric primary care in maintaining high-quality healthcare services during crises, evidence about service utilisation and provision remains limited especially in Germany. This study, therefore, explores the utilisation and provision of paediatric primary care services during the ongoing COVID-19 pandemic and their barriers and facilitators.Methods and analysisThe study uses a convergent mixed-methods design and comprises online surveys to parents, adolescents and primary care paediatricians (PCPs) and semistructured interviews with parents and PCPs. We recruit parents and adolescents from paediatric primary care practices and PCPs via email using mailing lists of the German Professional Association of Paediatricians and the German Society of Ambulatory Primary Care Paediatrics. The parent and adolescent surveys assess, inter alia, the utilisation of paediatric primary care services and its correlates, aspects of parental and child health as well as socioeconomic characteristics. The PCP survey investigates the provision of paediatric primary care services and its correlates, aspects of PCP health as well as sociodemographic and practice characteristics. The semistructured interviews with parents and PCPs explore several aspects of the online surveys in more detail. We use descriptive statistics and generalised linear mixed models to assess service utilisation and provision and specific correlates covered in the online surveys and apply qualitative content analysis to explore barriers and facilitators of service utilisation and provision more broadly in the semistructured interviews. We will integrate findings from the quantitative and qualitative analyses at the interpretation stage.Ethics and disseminationThe study was approved by the Medical Ethics Review Board of the Medical Faculty Mannheim at Heidelberg University (2020–650N). Study results will be published in journals with external peer-review.
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Abma, Inger L., Maroeska M. Rovers, Marijke IJff, Bernard Hol, Masha Nägele, Gert P. Westert e Philip J. van der Wees. "Does the Patient-Reported Apnea Questionnaire (PRAQ) increase patient-centredness in the daily practice of sleep centres? a mixed-methods study". BMJ Open 9, n.º 6 (junho de 2019): e025963. http://dx.doi.org/10.1136/bmjopen-2018-025963.
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ObjectivesThe objective of this exploratory study was to see how the Patient-Reported Apnea Questionnaire (PRAQ) may impact the daily clinical practice of sleep centres, and why it may or may not work as expected. The hypotheses were tested that this patient-reported outcome measure makes patients more aware of which of their health complaints may be related to obstructive sleep apnoea (OSA), and that it improves patient-centredness of care by shifting the focus of care away from (only) medical problems towards the individual burden of disease and quality of life.DesignMixed methods. The quantitative study (surveys, patient records) was a before-and-after study.SettingThree sleep centres in The Netherlands (secondary care).Participants27 patients and 14 healthcare professionals were interviewed. 487 patients completed surveys pre-implementation, and 377 patients completed surveys post-implementation of the PRAQ. For the health records, 125 patients were included in the pre-implementation group, and 124 other patients in the post-implementation group.InterventionsThe PRAQ was used in clinical practice for six successive months.Outcome measuresScores on individual survey items, number of patients receiving non-medical treatment, adjustment of treatment at first follow-up, compliance with treatment.ResultsPatients were generally positive about the usefulness of the PRAQ before and during the consultation, as they felt more informed. Healthcare providers did not consider the PRAQ very useful, and they reported minor impact on their consultations. The surveys and health record study did not show an impact of the PRAQ on clinical practice.ConclusionsImplementing the PRAQ may be beneficial to patients, but this study does not show much impact with regard to patient-centredness of care. New Dutch guidelines for OSA care may lead to a greater emphasis on quality of life and value of care for patients, making its integration in clinical care potentially more useful.
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Ong, William Lay Keat, Vineet Gauhar, Daniele Castellani e Jeremy Y. C. Teoh. "Tips and Pitfalls in Using Social Media Platforms for Survey Dissemination". Société Internationale d’Urologie Journal 4, n.º 2 (15 de março de 2023): 118–24. http://dx.doi.org/10.48083/perg3137.
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IntroductionSocial media has become a prevalent platform for survey dissemination, despite the paucity of literature on this topic. The purpose of this paper is to outline the benefits and drawbacks of and best practices for social media-based surveys.MethodsWe performed a scoping review of this topic and explored different strategies commonly employed for conducting efficient health care surveys via social media platforms.ResultsThe main advantages of social media-based surveys are the convenience and flexibility of survey design, their relatively low cost, the anonymity of responders, and the ability to reach a broader population of responders across geographical boundaries. Several measures can be adopted to avoid issues inherent in this approach, such as data disruption and response duplication, as well as to enhance ethical behaviors and consent compliance. We discuss limitations associated with unclear distribution of survey respondents and outline survey fraud as a major impediment to the online propagation of surveys on various social media platforms.DiscussionThe use of social media to disseminate surveys on various medical specialty topics has garnered global participation, particularly during the COVID-19 pandemic. Ethical codes of conduct emphasize the need for professionalism and truthfulness, and disclosure of potential conflicts of interest on the part of respondents, and high-quality survey research on the part of researchers.ConclusionWe advocate for the novel use of social media to promote large and diverse health care surveys. Additional studies should further explore the use of emerging social media platforms for survey dissemination and their impact on health care research.
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Chauhan, S., S. Bhoi, D. T. Sinha, M. Rodha, G. Adhikari, G. Sharma, K. Sharma e R. Kumar. "(P2-65) Perception of Emergency Care Providers Toward the Implementation of an Electronic Medical Record System in the Emergency Department of a Level-1 Trauma Center". Prehospital and Disaster Medicine 26, S1 (maio de 2011): s156—s157. http://dx.doi.org/10.1017/s1049023x11005097.
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BackgroundManual documentation has an inherent problem of improper communication, manipulation, and validity. An electronic medical record (EMR) is a computerized medical record created in an organization that delivers care, such as a hospital. EMRs tend to be a part of a local, stand-alone, health information system that allows for storage and retrieval.ObjectivesThe objective of this study was to assess the perception of emergency care providers toward the implementation of an EMR System in the emergency department of a Level-1 Trauma Center.MethodsA qualitative survey was conducted among consenting doctors and nurses in the emergency department of the All India Institute of Medical Sciences February to October 2010. Data were collected from a sample of 22—eight doctors and 14 nurses. The collection tool was a structured, closed-ended questionnaire of 12 questions based on usability, applicability, and security, of EMR. A Likert scale (LS) was used (1 = worst, 4 = best). Surveys were done on Day 20, Day 45, and after nine months of implementation of. Responses of emergency care providers were compiled and analyzed using SPSS version 16.ResultsThree surveys consisted of 22 participants in each survey. The survey domain of usability improved on Survey 3 (LS = 2.57), Survey 2 (LS = 2.46), Survey 1 (LS = 2.24). Application of EMR improved from Survey 1 to Survey 3. The data regarding perception of security concerns such as manipulation of data, transparency, and accountability were comparable among Survey 1, Survey 2, and Survey 3. Initial satisfaction was strongly associated with perception of usefulness of data mining for research purposes.ConclusionsSatisfaction with an EMR system at its implementation generally persisted through the first year of use. Implementation plans must include positive reinforcement regarding EMR among emergency care providers.
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Liakh, Anastasiia, Ali Dzhemiliey, Marta Antoniv, Marta Naumova, Viacheslauy Kopetsky, Inesa Huivaniuk, Andriy Beznosenko, Nelya Melnitchouk e Darya Kizub. "Enhancing Cancer Care in Ukraine: Insights From Doctor Perspectives on Diagnosis and Treatment Quality". JCO Global Oncology 10, Supplement_1 (julho de 2024): 62. http://dx.doi.org/10.1200/go-24-55000.
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PURPOSE Optimizing cancer care, including during the time of war, often begins with a needs assessment. We surveyed oncologists in Ukraine to evaluate existing gaps and describe strategies to address them. METHODS In January 2024, medical and surgical oncologists in Ukraine completed electronic surveys that were designed together with oncologists at the National Cancer Institute of Ukraine. These surveys included an open-ended question about how to improve the efficiency and quality of cancer care in one's practice. Surveys were distributed through oncology-focused social media in Ukraine. Data was analyzed using thematic analysis and descriptive statistics. RESULTS Fifty-three medical oncologists completed the survey. The most common suggestion for optimizing cancer care is improving provision of targeted cancer treatments and immunotherapy, cited by 19 (35.8%). Eighteen (34.0%) suggested ameliorating personnel shortages), while 10 (18.9%) desired an increased number of machines for chemotherapy infusion and 6 (11.3%) requested greater hospital bed capacity. Eighty-eight surgical oncologists completed the survey. The most common suggestion for improvement was increasing availability of disposable surgical kits and instruments, catheters, and drainage systems, cited by 23 (26.1%). Other common recommendations included more consistent provision of surgical equipment cited by 20 (22.72%), increasing the number of number of surgical staff cited by 13 (14.77%), improved healthcare facility funding cited by 12 (13.64%), increasing the quantity of operating rooms by 9 (10.23%), improved surgical staff training cited by 9 (10.23%), and reduced paperwork for surgeons recommended by 2 (2.27%). CONCLUSION We identified important gaps in medical and surgical oncology care in Ukraine, as well as strategies to address these from the point of view of physicians working in these areas. Results are limited by online convenience sampling.
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Naeem, Salman, Christopher Edmunds, Thomas Hirst, Julia Williams, Amir Alzarrad, James Ronaldson, Jon Barratt, East Anglian Air Ambulance Research, Audit, Innovation and Development Group e Pre-hospital Trainee Operated Research Network. "A National Survey of Prehospital Care Services of United Kingdom for Use, Governance and Perception of Prehospital Point of Care Ultrasound". POCUS Journal 7, n.º 2 (21 de novembro de 2022): 232–38. http://dx.doi.org/10.24908/pocus.v7i2.15739.
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Introduction: Point of care ultrasound (POCUS) has become a common practice in prehospital care over the last 10 years. There is lack of literature on its use and governance structure in United Kingdom (UK) prehospital care services. We aimed to survey the use, governance of prehospital POCUS among UK prehospital services and perceptions of clinicians and services regarding its utility and barriers to its implementation. Methods: Four electronic questionnaire surveys were delivered to UK helicopter emergency medical service (HEMS) & clinicians, ambulance and community emergency medicine (CEM) services between 1st of April and 31st of July 2021 investigating current use, governance structure for POCUS and perception about its benefits and barriers. Invitations were sent via email to medical directors or research leads of services and using social media. Survey links remained live for two months each. Results: Overall, 90%, 62% and 60% of UK HEMS, ambulance and CEM services respectively, responded to surveys. Most of the services used prehospital POCUS, however only two HEMS organisations fulfilled the Royal College of Radiology governance criteria for POCUS. The most commonly performed POCUS modality was echo in cardiac arrest. Majority of clinicians judged POCUS to be beneficial and the common perceived benefit was promotion of enhanced and effective clinical care. Major barriers to its implementation included a lack of formal governance, limited literature supporting its use and difficulties in performing POCUS in prehospital environment. Conclusion: This survey demonstrates that prehospital POCUS is being provided by a majority of the prehospital care services and clinicians have found it beneficial in providing enhanced clinical care to their patients. However, the barriers to its implementation are relative lack of governance structure and supportive literature.
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Kolko, David J., Eunice Torres, Kevin Rumbarger, Everette James, Renee Turchi, Cheryl Bumgardner e Connell O’Brien. "Integrated Pediatric Health Care in Pennsylvania: A Survey of Primary Care and Behavioral Health Providers". Clinical Pediatrics 58, n.º 2 (17 de novembro de 2018): 213–25. http://dx.doi.org/10.1177/0009922818810881.
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This study reports on a statewide survey of medical and behavioral health professionals to advance the knowledge base on the benefits and obstacles to delivering integrated pediatric health care. Surveys distributed in 3 statewide provider networks were completed by 110 behavioral health specialists (BHSs) and 111 primary care physicians (PCPs). Survey content documented their perceptions about key services, benefits, barriers, and needed opportunities related to integrated care. Factor analyses identified 8 factors, and other items were examined individually. We compared responses by specialty group (BHS vs PCP) and integrated care experience (no vs yes). The findings revealed differences across domains by specialty subgroup. In several cases, BHS (vs PCP) respondents, especially those with integrated care experience, reported lower benefits, higher barriers, and fewer resource requests. The implications of these results for enhancing care integration development, delivery, training, and research are discussed along with the study’s limitations and empirical literature.
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Halpern, Michael T., Mallorie Fiero e Melanie Bell. "Factors affecting multidimensional caregiver burden: Results from national surveys." Journal of Clinical Oncology 34, n.º 7_suppl (1 de março de 2016): 301. http://dx.doi.org/10.1200/jco.2016.34.7_suppl.301.
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301 Background: Quality of care for individuals with cancer is affected by the burden on their caregivers. For high quality care, it is important to understand domains of caregiver burden and factors affecting this burden. Methods: Using data from two national surveys, the National Survey of Caregiving (NSOC) linked to the National Health and Aging Trends Survey (NHATS), we identified all participants in the NHATS diagnosed with cancer who had a caregiver participating in the NSOC. Twenty-two items in the NSOC related to caregiver health, mood and outlook were included in factor analysis to develop scales capturing domains of burden. Multivariable regression analyses examined whether activities performed by caregivers and supports for caregivers were associated with these burden scales. Results: Analysis of responses from 245 caregivers of cancer patients identified three scales: emotional burden; psychological burden; and relationship with the patient. Providing assistance managing medical care was associated with increased emotional and psychological burden, while assistance with non-medical issues was increased psychological burden and worsened relationships with patients. Caregiver provision of direct patient care activities was also associated with increased burden but improved relationships with patients. Use of support services showed mixed associations with burden. Conclusions: Using a nationally-representative sample of cancer patients and their caregivers and brief publicly-available survey questions, we present three scales addressing different aspects of caregiver burden that are responsive to caregiver activities and social supports. This may assist in developing and evaluating intervention to decrease caregiver burden and thereby improve quality of care for individuals with cancer.
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Anastasio, Geraldine D., e Allen E. Shaughnessy. "Salary Survey of Ambulatory Care Clinical Pharmacists". Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy 17, n.º 3 (6 de maio de 1997): 565–68. http://dx.doi.org/10.1002/j.1875-9114.1997.tb03066.x.
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To determine salary and selected fringe benefits of members of the Ambulatory Care Practice and Research Network of the American College of Clinical Pharmacy, we developed a self‐administered questionnaire that surveyed demographic information, schooling and training, academic appointments, yearly salary (as of February 1, 1995), source of salary, outside income, annual raise, vacation time, financial support for continuing education, and board certification. Ninety‐nine surveys were returned (return rate 46%). Respondents were mostly women (58%), their average age was 34 years (range 25–51 yrs), and they had a median of 5 years in the work force. Most respondents (67%) had residency training, whereas only 21% had fellowship experience. Board certification was reported by 46%. The median salary was $53,500 (average $55,861, range $35–90k), with progression for academic rank. The last salary increase averaged 3.7%. Most (93%) respondents received an average of $1509 for travel. The survey represents a young work force. The salaries vary but show progression for accomplishment.
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Kemp, Kyle A., Paul Fairie, Brian Steele, Deborah McNeil, Seija Kromm, David Johnson e Maria J. Santana. "The Experience of Parents of Hospitalized Children Living With Medical Complexity". Hospital Pediatrics 11, n.º 10 (1 de outubro de 2021): 1065–72. http://dx.doi.org/10.1542/hpeds.2020-003038.
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BACKGROUND AND OBJECTIVES Children living with medical complexity (CMC) experience frequent hospital admissions. Validated patient-reported experience measures may inform care improvements in this cohort. Our objectives were to examine the comprehensive inpatient experience of CMC by using a validated patient-reported experience measure and compare the results with all other respondents at 2 academic pediatric hospitals in a western Canadian province. METHODS Parents completed the Child Hospital Consumer Assessment of Healthcare Providers and Systems survey. Surveys were linked with inpatient records, and an accepted case definition was used to extract records pertaining to CMC. Results were reported as percent in “top box,” represented by the most positive answer choice to each measure. Odds of reporting a top box response were calculated while controlling for demographic and clinical features. RESULTS From October 2015 to March 2019, 4197 surveys (1515 CMC; 2682 non-CMC) were collected. Among CMC, the highest-rated measures pertained to being kept informed while in the emergency department, a willingness to recommend the hospital, and parents having a clear understanding of their role in their child’s care. The lowest-rated measures pertained to preventing mistakes and reporting concerns and the quietness of the hospital room at night. Compared with others, parents of CMC reported lower raw results on 20 of the 28 measures. They also reported lower a odds of reporting a top box score on 2 measures and higher odds on 1. CONCLUSIONS Parents of CMC revealed many perceived gaps. These findings can be used to inform strategies to improve care among CMC and policies to support the care of CMC and their families.
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Stronge, Kirsty, e Jennie Burch. "Education in stoma care: a survey and interviews with stoma care nurses". Gastrointestinal Nursing 17, n.º 8 (2 de outubro de 2019): 26–31. http://dx.doi.org/10.12968/gasn.2019.17.8.26.
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Guidance for stoma care clinical nurse specialists (CNSs) provided by the Association of Stoma Care Nurses (ASCN) UK and Royal College of Nursing (RCN) states that senior nurses are expected to have at least a degree-level specialist qualification in conjunction with clinical experience. To determine how to better meet the educational needs of stoma care CNSs, data were collected from this group of professionals. One-in-five stoma care CNS in the UK replied to an online survey, plus telephone interviews. The findings showed that, when attending a course, accreditation was important, as well as that education was predominantly used for professional development and underpinning clinical knowledge. There were three themes that emerged from the surveys and interviews: development of education, delivery style and future developments. These were felt to be important to the nurses when attending educational courses.
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Romanov, Alexey. "Assessment of patient satisfaction with medical care: methodological and practical recommendations". Glavvrač (Chief Medical Officer), n.º 5 (1 de maio de 2020): 69–74. http://dx.doi.org/10.33920/med-03-2005-08.
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The article is devoted to methods of assessing patient satisfaction with medical care provided. According toRussian literature sources, the author analyzes the advantages and disadvantages of analyzing public complaints, surveys, interviews, and other possible methods. The author concludes that it is appropriate to use methods to assess patient satisfactionwithmedical care in accordancewith the tasks that the researcherfaces.
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Smith, Tucker, Olivia Hess, Rachel Pryor, Michelle Doll e Gonzalo Bearman. "Addressing frontline healthcare worker perspectives on hand-hygiene monitoring badges". Antimicrobial Stewardship & Healthcare Epidemiology 3, S2 (junho de 2023): s72. http://dx.doi.org/10.1017/ash.2023.321.
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Background: Hand-hygiene technology (HHT) intends to monitor and promote hand washing by healthcare workers, a critical measure of infection control. Healthcare worker noncompliance with HHT is a major limitation to its implementation and utility in clinical settings. We assessed perspectives on HHT in an academic hospital system. Methods: Hand-hygiene team members created an anonymous, 37-question, Likert-scale survey to assess healthcare worker attitudes toward HHT. Surveys targeted nursing staff, advanced practice providers, care partners, and internal medicine physicians. Clinical coordinators from 5 distinct nursing units and 1 physician department emailed surveys to eligible employees. Research coordinators and clinical coordinators also posted a QR code for survey fliers at nursing stations. Results: Overall, 120 surveys were completed. Most surveys were completed by nurses and physicians (66.4% and 14.0%). Most respondents (67.5%) do not find HHT useful. Additionally, 78.3% of respondents believe that HHT does not accurately record hand-washing events. Most (78.3%) do not like using HHT, and 75.8% find it annoying. Only 10.8% believe that patient care suffers because of HHT. Conclusions: Most healthcare workers dislike the HHT badges, primarily due to perceived inaccuracies, lack of utility, burden of use, and pressure to comply. Distrust and effect on patient care do not appear to be substantial factors contributing to negative perceptions of HHT. Weaknesses of the study include overrepresentation of nursing staff and potential bias because respondents may have provided exceptionally negative responses believing it could lead to the removal of HHT.Disclosures: None
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Nau, David P., e David B. Brushwood. "State Pharmacy Regulators' Opinions on Regulating Pharmaceutical Care Outcomes". Annals of Pharmacotherapy 32, n.º 6 (junho de 1998): 642–47. http://dx.doi.org/10.1345/aph.17354.
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OBJECTIVE: To examine the opinions of state pharmacy regulators regarding responsibility for the outcomes of drug therapy, and approaches that might be taken to regulate for pharmaceutical care outcomes. DESIGN: Surveys were sent to the executive secretaries of state pharmacy boards. The executive secretaries were encouraged to seek input from other board staff and board members in formulating a response. Reminder postcards were sent to all subjects 1 week after the initial mailing. MEASURES: The survey instrument was divided into three sections. The first section identified 10 approaches that state boards could use to regulate for outcomes and asked subjects to indicate the utility of each. The second and third sections asked the subjects to determine the extent to which pharmacies and pharmacists, respectively, should be responsible for outcomes potentially related to pharmaceutical care. RESULTS: Forty-one usable surveys were returned. All approaches to regulation were viewed as potentially useful, and scores for three approaches indicated that they would be consistently helpful for effective regulation of pharmaceutical care outcomes. The pharmacy was viewed as solely responsible for poor outcomes related to systems deficiencies, a lack of self-assessment, inadequate references, equipment, and technician support. Pharmacists were assigned greatest responsibility for outcomes related to prescription filling, and less responsibility for outcomes related to patient care. However, there was considerable variation in responses to many of the items, reflecting the diverse opinions of pharmacy regulators on these issues. CONCLUSIONS: While pharmacy regulators appear open to some outcomes-oriented approaches to regulation, there is no clear consensus on responsibility for pharmaceutical care outcomes.
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Maleki, Sam, Marliese Alexander, Chen Liu, Danny Rischin, Senthil Lingaratnam e Tsien Fua. "Radiation oncology outpatient medication management needs and service gaps – A cross-sectional study of patients and clinicians". Journal of Oncology Pharmacy Practice 26, n.º 4 (25 de setembro de 2019): 846–52. http://dx.doi.org/10.1177/1078155219875210.
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Background Patients receiving radiotherapy for the treatment of cancer can have complex medication requirements related to the management of side-effects and impaired swallowing ability. This study surveyed patients and clinicians to identify service gaps and unmet medication management needs. Methods Patient and clinician surveys were developed by a multidisciplinary team based on previously validated questionnaires. The patient survey focused on medication use and adherence. The clinician survey was based around a clinical case study and focused on identifying service gaps and practice variations. This survey was disseminated to radiation oncologists, pharmacists and nurses involved with the care of head and neck or lung cancer patients in Victoria. Results A total of 93 surveys were completed including 53 patient surveys and 40 clinician surveys. Radiotherapy patients reported high medication usage with up to 53% taking five or more medications daily. When asked the same set of questions relating to medication education requirements, patients receiving polypharmacy reported greater needs (72%) than recognised by the surveyed multidisciplinary clinician group (58%). They also reported a non-adherence rate of 46%. In addition, further disparities were identified in clinician practices and their approach to clinical situations which may result in conflicting advice and confusion for patients. Conclusion While recognising deficiencies relating to the provision of medication information, oncologists, nurses and pharmacists underestimated patient needs for medication information, education and follow-up. Findings support the rationale for integration of pharmacy services within the radiotherapy clinics to support patient care and bridge service gaps relating to medication management.
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Peltz-Rauchman, Cathryn D., George Divine, Daniel McLaren, Ilan S. Rubinfeld, William A. Conway, David Allard e Christine Cole Johnson. "Response to survey directed to patient portal members differs by age, race, and healthcare utilization". JAMIA Open 2, n.º 4 (11 de novembro de 2019): 429–33. http://dx.doi.org/10.1093/jamiaopen/ooz061.
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Abstract Health care systems are increasingly utilizing electronic medical record—associated patient portals to facilitate communication with patients and between providers and their patients. These patient portals are growing in recognition as potentially valuable research tools. While there is much information about the response rates and demographics of internet-based surveys as well as the demographics of patients who are portal members, not much is known about the response rate of internet-based surveys directed to a group of patient portal members or the demographics of which portal members respond to internet-based surveys issued within that specific population. The objective of these analyses was to determine the demographics of patient portal users who respond to an internet-based survey request. We hypothesized that respondents would more likely be: (1) older (65+), (2) European American, (3) married, (4) female, (5) college educated, (6) have higher medical care utilization, (7) have more comorbidities, and (8) have a private practice primary care physician (as opposed to a salaried group practice primary care physician). We found that our respondents tended to be older, of European geographic ancestry, and more frequent users of healthcare. While patient portal members are an easily identifiable and contactable group that are potentially valuable participants for research, it is important to understand that respondents to surveys solicited from this sampling frame may not be entirely representative. It will be important to develop strategies to more fully engage populations that represent the target population in order to increase overall and subgroup response rates.
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Dharmaraj, Blossom, Sherri Adams, Madison Beatty, Clara Moore, Arti Desai, Leah Bartlett, Erin Culbert, Eyal Cohen, Jennifer Stinson e Julia Orkin. "81 The Use of Online Care-Maps for Children with Medical Complexity". Paediatrics & Child Health 26, Supplement_1 (1 de outubro de 2021): e59-e60. http://dx.doi.org/10.1093/pch/pxab061.064.
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Abstract Primary Subject area Complex Care Background Children with medical complexity (CMC) are a highly medicalized population of children who require specialized care across various settings including the hospital, home and community, making care coordination challenging. Care-maps, a visual representation of the people and places involved in a patient’s care, are one such tool to facilitate care coordination (Figure 1). To date, care-maps have not yet been used in a clinical environment, examined in real time or used via a standardized approach. Objectives The aims of our study were to develop a shareable standardized online tool that supports the parental creation of a care-map, and to assess the utility of care-maps in clinical care from a parent, health care provider (HCP), and community perspective. Design/Methods Parents of CMC were invited to use a standardized online care platform called Connecting2gether for 6-months and create online care-maps that could be shared with their HCPs and other community members (i.e., teachers, secondary caregivers). Demographics and internet usage surveys were completed at baseline and an acceptability survey was completed at 6-months. Surveys were analyzed using descriptive methods and care-maps were analyzed via descriptive visual analysis. Results Thirty-seven parents enrolled on the platform and 25 (70%) created a care-map and used it for the duration of the study. Of the 25, 14 (66%) went back and made revisions and 17 (80%) reported using it in clinic, home or school. Visual analysis demonstrated 11 categories (bubbles) that were commonly included. All care-maps included a Medical Team, School/Daycare and Family and Friends category, which automatically populated. The majority of care-maps included a central child bubble with the child’s photo (92%), and Community Medical Services (i.e. rehab centers) (60%). Less frequent categories included Home Care (28%), Goals (16%), and 12% included What I Like, Funding, and Community/Foundation individual bubbles. Some parents reported initial uncertainty, but at end-of-study, some reported care-maps as the most useful feature of the platform. Fifty seven percent (12/23) of HCPs viewed the created care-map and only 20% used it in the child’s care. The majority (83%) of HCPs specifically valued seeing the big picture of the child’s care, found it easy to navigate and the detail it provided. Conclusion The ability of care-maps to illustrate the intricate web of medical and non-medical care supporting CMCs in their daily life provides insight and value for parents, HCPs and non-HCPs. Care-maps were found to be valuable from the perspective of HCPs. Parents reported initial uncertainty, highlighting the importance of the HCP promoting the use of care-maps with their patients and families.
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__, _. "Organization of Sociological Surveys of Patients/Their Representatives and Medical Personnel in Health Care (Guidelines)". Family Medicine, n.º 5 (30 de dezembro de 2016): 118–25. http://dx.doi.org/10.30841/2307-5112.5.2016.248812.
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Reddy, Suresh, Sriram Yennu, Kimberson Cochien Tanco, Aimee Elizabeth Anderson, Diana Guzman, Janet L. Williams, Diane D. Liu e Eduardo Bruera. "Frequency of burn-out among palliative care physicians participating in continuing medical education." Journal of Clinical Oncology 37, n.º 31_suppl (1 de novembro de 2019): 77. http://dx.doi.org/10.1200/jco.2019.37.31_suppl.77.
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77 Background: There is a growing concern about high frequency of burn out (BO) among physicians, and higher among palliative care providers, reported to be in the range of 62%. There are very limited studies done among Palliative Care (PC) physicians. Objective: The main objective of our study was to determine the frequency of burnout among PC physicians participating in PC Continuing Medical Education (CME). Secondary objectives included determining characteristics of physicians who expressed higher BO and also to determine overall attitudes towards PC practice. Methods: During 2018 Annual Hospice & Palliative Medicine Board Review Course, we conducted a survey of 41 questions to determine the frequency of BO among physicians. This included Maslach Burn Inventory ( MBI )–General. The survey was given to both the in house and webinar participants. Results: Of 110 physicians who were given the surveys, 91/110 (83%) completed surveys. The median age was 48 years with 59 (65%) being females, 74 (81%) married. Majority, 41 (46%) were in community practice. 24 (38%) were in practice for more than 6 years, and 52 (57%) were board certified. 56 (62%) practiced PC for more than 50 % of time. Majority, 69 (76%) were doing clinical work. The median number of physician in the group practice was 3. 35 (38 %) of participants reported at least one symptom burnout based on MBI criteria. Only being single/separated correlated significantly with burn-out (p = 0.056). PC work is appreciated at their place of work by 73 (80%), 58 (64%) reported insurance was a burden, electronic medical record as a burden by 58 (64%), and 82 (90%) of physicians felt optimistic about continuing PC in future. Conclusions: BO among palliative care physicians who attended a board review course tends to be high, but lower than previously reported. Physicians who choose to attend CME may have unique motivating characteristics to cope better with stress and BO. More research is needed to better characterize BO among PC physicians.
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Schunk, Michaela, Renée Stark, Peter Reitmeir, Christa Meisinger e Rolf Holle. "Towards Patient-Oriented Diabetes Care: Results from Two KORA Surveys in Southern Germany". Journal of Diabetes Research 2015 (2015): 1–14. http://dx.doi.org/10.1155/2015/368570.
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Objective. This study aims to examine the relationship of diabetes care processes and patient outcomes with an expanded set of indicators regarding patient-oriented care delivery, such as treatment satisfaction, the quality of patient-physician relationship, and a wider range of patient outcomes such as self-management, health behaviour, disease-related burden, and health-related quality of life (HRQL).Methods. The study population consisted of 486 participants with type 2 diabetes in two population-based follow-up surveys, conducted in 2003 to 2005 and 2006 to 2008 in Southern Germany. Data were self-reported and questionnaire-based, including the SF-12 for HRQL. Multiple regression models were used to identify associations between care processes and outcomes with adjustment for confounders.Results. Frequent medical examinations increased the likelihood of self-monitoring activities, such as foot care. A positive patient experienced relationship with their physician is associated with higher adherence to medical recommendations, such as medication intake, and the score of the SF-12 mental component. Participants with diabetes-related complications reported higher levels of medical examinations and multiprofessional care.Conclusions. Indicators of patient-oriented care should become an indispensable part of diabetes clinical practice guidelines with the aim of striving for more effective support of patients.
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Agrawal, Rishi, Parag Shah, Kathy Zebracki, Kathy Sanabria, Claire Kohrman e Arthur F. Kohrman. "Barriers to Care for Children and Youth With Special Health Care Needs". Clinical Pediatrics 51, n.º 1 (19 de agosto de 2011): 39–45. http://dx.doi.org/10.1177/0009922811417288.
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Objective. To assess primary care pediatricians’ (PCPs’) perceptions of caring for children and youth with special health care needs (CYSHCN). Methods. Cross-sectional survey of Illinois pediatricians. Results. Thirty-five percent of surveys were returned and 26% were analyzed. The top 3 perceived barriers were insufficient time (72%), insufficient reimbursement (68%), and lack of support services (59%). Insufficient interest was the least cited barrier (19%). Preparedness to perform tasks related to care of CYSHCN ranged from 89% for accessing early intervention services to 24% for billing and coding. The percentage of PCPs somewhat or very comfortable providing primary care to patients with technology dependence ranged from 75% for blood glucose monitoring to 12% for dialysis. Conclusions. The issues of time, reimbursement, billing, and coding are perceived as significant barriers to the care CYSHCN. There is substantial variation in PCPs’ comfort in the care of CYSHCN who require the assistance of medical technologies.