Oncologists' perspectives on post-cancer treatment communication and care coordination with primary care physicians

Post-treatment cancer care is often fragmented and of suboptimal quality. We explored factors that may affect cancer survivors' post-treatment care coordination, including oncologists' use of electronic technologies such as e-mail and integrated electronic health records (EHRs) to communicate with primary care physicians (PCPs). We used data from a survey (357 respondents; participation rate 52.9%) conducted in 2012-2013 among medical oncologists caring for patients in a large US study of cancer care delivery and outcomes. Oncologists reported their frequency and mode of communication with PCPs, and role in providing post-treatment care. Seventy-five per cent said that they directly communicated with PCPs about post-treatment status and care recommendations for all/most patients. Among those directly communicating with PCPs, 70% always/usually used written correspondence, while 36% always/usually used integrated EHRs; telephone and e-mail were less used. Eighty per cent reported co-managing with PCPs at least one post-treatment general medical care need. In multivariate-adjusted analyses, neither communication mode nor intensity were associated with co-managing survivors' care. Oncologists' reliance on written correspondence to communicate with PCPs may be a barrier to care coordination. We discuss new research directions for enhancing communication and care coordination between oncologists and PCPs, and to better meet the needs of cancer survivors post-treatment

Co-production in practice : how people with assisted living needs can help design and evolve technologies and services

Background The low uptake of telecare and telehealth services by older people may be explained by the limited involvement of users in the design. If the ambition of ‘care closer to home’ is to be realised, then industry, health and social care providers must evolve ways to work with older people to co-produce useful and useable solutions. Method We conducted 10 co-design workshops with users of telehealth and telecare, their carers, service providers and technology suppliers. Using vignettes developed from in-depth ethnographic case studies, we explored participants’ perspectives on the design features of technologies and services to enable and facilitate the co-production of new care solutions. Workshop discussions were audio recorded, transcribed and analysed thematically. Results Analysis revealed four main themes. First, there is a need to raise awareness and provide information to potential users of assisted living technologies (ALTs). Second, technologies must be highly customisable and adaptable to accommodate the multiple and changing needs of different users. Third, the service must align closely with the individual’s wider social support network. Finally, the service must support a high degree of information sharing and coordination. Conclusions The case vignettes within inclusive and democratic co-design workshops provided a powerful means for ALT users and their carers to contribute, along with other stakeholders, to technology and service design. The workshops identified a need to focus attention on supporting the social processes that facilitate the collective efforts of formal and informal care networks in ALT delivery and use

Extraction and Analysis of Data for Fragility Fracture Patients to Help Determine the Likelihood of Follow-Up With a West Michigan Fragility Fracture Service

Fragility fractures and secondary fractures are a large physical, financial, and emotional drain on the individuals and families affected. Improving post fragility fracture care and increasing follow-up rates with specialty services, such as a fracture liaison service, may promote post-fracture recovery and help prevent future fractures. The purpose of this doctoral project was to increase and improve post osteoporotic fracture care by increasing appropriate referrals and follow-up care. Patient data was retrieved and analyzed on 60 fragility fracture patients referred to a local fracture liaison service. The analysis found that patient gender, fracture site, and history of a previous fracture all played a significant role as to whether the patient would follow-up with a fracture liaison service. The Health Belief Model and the Donabedian model were used to help drive this project and provide structure to the next steps in the project. To make the results relevant to primary care providers, local outcome data was used to provider a presentation to the group. The primary care providers then completed a survey answering questions based on their impression of the patient data presentation. The provider survey response data was then analyzed for trends. Most notably, the vast majority of providers agreed that after the presentation, they had a greater understanding of the patients that were most likely to receive inadequate fragility fracture care or refuse follow-up with a fracture liaison service. This implies that the providers now have a raised awareness about these patients and fewer patients will fall through the cracks when it comes to fragility fracture care and fracture liaison service follow-up. This project format could be applied to other populations to assist in revealing each unique population’s characteristics that impact fragility fracture care and fracture liaison service follow-up. Those results could then be presented to local primary care providers to raise awareness and improve their local outcomes

Online Social Support in the Saskatchewan Heart Failure Network: An Interpretive Description Approach

The management and prevention of cardiovascular disease is one of the most significant challenges to the health care system, both nationally and internationally. Health 2.0 is a term that denotes the use of web-based tools by health care professionals to communicate with patients, collaborate with other health professionals, and provide health information. The purpose of this interpretive description research study was to explore the factors that have and will continue to influence or contribute to caregivers' use of social networking as a form of social support when a family member is learning to live well with heart failure. The researcher created, designed, and developed a social networking site for caregivers. Following focus group sessions with health care professionals, the Living Well with Heart Failure NING site was reviewed and approved for use. Six caregivers participated on the website and were interviewed before and after participation. The results of this research study provided an insight into the factors that have contributed to the caregivers' search for online sources of health information and peer support. The caregivers’ and health care professionals' perceived consequences of utilizing online resources and social support are also identified. Health care professionals and caregivers found the social networking site easy to use, recommended the use of a moderator, and stressed the need for reliable and trustworthy information. Recommendations for health regions, health care professionals, caregivers, web developers and nurse educators are provided along with implications for nursing practice