What does it take to make integrated care work? A ‘cookbook’ for large-scale deployment of coordinated care and telehealth

The Advancing Care Coordination & Telehealth Deployment (ACT) Programme is the first to explore the organisational and structural processes needed to successfully implement care coordination and telehealth (CC&TH) services on a large scale. A number of insights and conclusions were identified by the ACT programme. These will prove useful and valuable in supporting the large-scale deployment of CC&TH. Targeted at populations of chronic patients and elderly people, these insights and conclusions are a useful benchmark for implementing and exchanging best practices across the EU. Examples are: Perceptions between managers, frontline staff and patients do not always match; Organisational structure does influence the views and experiences of patients: a dedicated contact person is considered both important and helpful; Successful patient adherence happens when staff are engaged; There is a willingness by patients to participate in healthcare programmes; Patients overestimate their level of knowledge and adherence behaviour; The responsibility for adherence must be shared between patients and health care providers; Awareness of the adherence concept is an important factor for adherence promotion; The ability to track the use of resources is a useful feature of a stratification strategy, however, current regional case finding tools are difficult to benchmark and evaluate; Data availability and homogeneity are the biggest challenges when evaluating the performance of the programmes

Re-thinking technology and its growing role in enabling patient empowerment

© The Author(s) 2018. The presence and increase of challenges to eHealth in today’s society have begun to generate doubts about the capability of technology in patient empowerment, especially within the frameworks supporting empowerment. Through the review of existing frameworks and articulation of patient demands, weaknesses in the current application of technology to support empowerment are explored, and key constituents of a technology-driven framework for patient empowerment are determined. This article argues that existing usage of technology in the design, development and implementation of patient empowerment in the healthcare system, although well intentioned, is insufficiently constituted, primarily as a result of fragmentation. Systems theory concepts such as holism and iteration are considered vital in improving the role of technology in enabling patient empowerment

End-of-Life Heart Failure Education With Staff Nurses; A Quality Improvement Project

Presented to the Faculty of the University of Alaska Anchorage in Partial Fulfillment of the Requirements for the Degree of MASTER OF SCIENCEHeart failure (HF) is a serious diagnosis and a major public health concern. The symptoms can be exhausting and can vary from person to person with periods of acute exacerbations requiring hospital admission. It is important for hospital staff nurses to be able to speak with knowledge and comfort about end‐of‐life planning. The purpose of this quality improvement project was to increase nurses’ awareness of the functional classification systems of HF, options and timing for palliative care, and describe nurses’ intent to use the information in practice. Nurses reported planning on using the information to “Be more Sensitive and Listen.” The prevailing theme to barriers to implementing this into practice was “Not enough time and discomfort.” Nurses who were comfortable having end‐of‐life discussions did not feel they had enough time, and those who were not comfortable did not engage because of discomfort toward the topic. Furthermore, recommendations from this study were the addition of a supportive palliative care team to manage patients with HF.End-of-Life Heart Failure Education with Staff Nurses; A Quality Improvement Project / Abstract / Table of Contents / Project / Background and Significant / Project Purpose / Literature Review / Methods / Analysis and Findings / Dissemination / Discussion / Conclusion / Impact on Practice / References / Appendix A New York Heart Failure Classification System / Appendix B Plan-Do-Check-Act Cycle / Appendix C Consent Form / Appendix D IRB Approval Letter / Appendix E Permission Letter / Appendix F Pre-Education Survey / Appendix G Post-Education Survey / Appendix H Case Study #1 / Appendix I Case Study #2 / Appendix J 'Do' Phase Education Intervention Lesson Plan / Appendix K Themes from QI Projec

"It's a whole package" : Type 2 diabetes and what it means for the body, life and self of people of Indian origin in New Zealand : a thesis presented in partial fulfillment of the requirements for the degree of Master of Arts in Psychology (with an endorsement in Health Psychology) at Massey University, Albany, New Zealand

Type 2 diabetes represents a considerable health problem for the Indian population group in New Zealand. In order to minimise the risk posed by this disease, recommended therapeutic goals include glycaemic control, maintaining a healthy weight and strict control of blood pressure. Culturally derived understandings of the illness and options for management will affect the way in which the person of Indian origin reacts to diabetes. This study looked at the way in which Type 2 diabetes is constructed and positioned while reflecting on how Indian culture might affect the way in which diabetes is interpreted and experienced. Seven males and five females, identifying themselves as being of Indian origin and managing Type 2 diabetes without the use of insulin were selected for the study. Semi-structured interviews were taped, transcribed and analysed using a reflexive approach to Foulcauldian discourse analysis Understanding diabetes begins through describing and accounting for the diabetic body which is believed to be different to other bodies. The way in which the person with diabetes might chose to control the disease and minimise harm to the body is validated by particular beliefs in cause and nature. As a result, the person with diabetes is able to construct a constantly evolving picture of the way in which the disease develops, what can be expected of it and what diabetes means for them, for their families and social connections. All this takes place within the particular social and cultural perceptual system of the person of Indian origin and the environment within which they live their every-day lives. The person with diabetes is actively engaged in processing new information, weighing options and defining who they are, not merely as someone with diabetes but as multi-dimensional individuals. Drawing on different constructions of the self, to justify and explain actions taken, opens up or limits access to opportunities to make changes and embrace new behaviors to manage their diabetes

Chronic illness care for Aboriginal and Torres Strait Islander people: final report

This project engage a range of stakeholders across different levels of the primary health care system, including service providers, management, policy-makers and researchers and capture their knowledge on the barriers and enablers to addressing the identified priority-evidence practice gaps and their suggestions on strategies for improvement. Overview The purpose of this project is to engage key stakeholders in the use of aggregate continuous quality improvement (CQI) data to identify and address system-wide evidence-practice gaps in Aboriginal and Torres Strait Islander chronic illness care. We aimed to engage a range of stakeholders across different levels of the primary health care (PHC) system, including service providers, management, policy-makers and researchers and capture their knowledge on the barriers and enablers to addressing the identified priority-evidence practice gaps and their suggestions on strategies for improvement. Our research has highlighted the wide variation in performance between different aspects of care and between health centres. While many aspects of care are being done well in many health centres, there are important gaps between evidence and practice in some aspects of PHC. System-wide gaps are likely to be due to deficiencies in the broader (PHC) system, indicating that system-level action is required to improve performance. Such system-level action should be developed with a deep understanding of the holistic nature of Aboriginal and Torres Strait islander wellbeing beyond just physical health (including healthy connections to culture, community and country), of the impact of Australian colonist history on Aboriginal and Torres Strait Islander people, and of how social systems – including the health system - should be shaped to meet the needs of Aboriginal and Torres Strait Islander people. This project aims to build on the collective strengths within PHC services in order to continue improving the quality of care for Aboriginal and Torres Strait Islander communities

Conceptualizing pathways linking women's empowerment and prematurity in developing countries.

BackgroundGlobally, prematurity is the leading cause of death in children under the age of 5. Many efforts have focused on clinical approaches to improve the survival of premature babies. There is a need, however, to explore psychosocial, sociocultural, economic, and other factors as potential mechanisms to reduce the burden of prematurity. Women's empowerment may be a catalyst for moving the needle in this direction. The goal of this paper is to examine links between women's empowerment and prematurity in developing settings. We propose a conceptual model that shows pathways by which women's empowerment can affect prematurity and review and summarize the literature supporting the relationships we posit. We also suggest future directions for research on women's empowerment and prematurity.MethodsThe key words we used for empowerment in the search were "empowerment," "women's status," "autonomy," and "decision-making," and for prematurity we used "preterm," "premature," and "prematurity." We did not use date, language, and regional restrictions. The search was done in PubMed, Population Information Online (POPLINE), and Web of Science. We selected intervening factors-factors that could potentially mediate the relationship between empowerment and prematurity-based on reviews of the risk factors and interventions to address prematurity and the determinants of those factors.ResultsThere is limited evidence supporting a direct link between women's empowerment and prematurity. However, there is evidence linking several dimensions of empowerment to factors known to be associated with prematurity and outcomes for premature babies. Our review of the literature shows that women's empowerment may reduce prematurity by (1) preventing early marriage and promoting family planning, which will delay age at first pregnancy and increase interpregnancy intervals; (2) improving women's nutritional status; (3) reducing domestic violence and other stressors to improve psychological health; and (4) improving access to and receipt of recommended health services during pregnancy and delivery to help prevent prematurity and improve survival of premature babies.ConclusionsWomen's empowerment is an important distal factor that affects prematurity through several intervening factors. Improving women's empowerment will help prevent prematurity and improve survival of preterm babies. Research to empirically show the links between women's empowerment and prematurity is however needed

Realist evaluation of the impact of paediatric nurse practitioner clinics, specialist paediatric nurses, and a children’s community nursing team in deflecting attendance at emergency departments and urgent care centres by children with long-term conditions

In 2018, the Greater Manchester Children’s Health and Wellbeing Board developed a 10-point strategy to achieve its objectives, the sixth of which was to reduce unnecessary hospital attendances and admissions for children with long term conditions such as asthma, diabetes and epilepsy. Funding was secured from Manchester Academic Health Science Centre to commission an exploration of the impact of the Paediatric Nurse Practitioner Clinic within the context of the Family Services Model and the impact that the service was having on reducing attendance at urgent care centres or admission to hospital. Alternatives to taking children to the ED/UCC can be a preference. An integrated system, with elements able to book directly into others, with rapid access, information, health promotion, and follow-up were essential to success. Extra consultation time for proactive intervention, with sufficient nurses to provide a seven-days service were valued. Advertisement of the service to the public and to professionals is vital for uptake by professionals and the public

Cost, outcomes, treatment pathways and challenges for diabetes care in Italy

Background: In Italy both incidence and prevalence of diabetes are increasing and age at diagnosis is decreasing in type 2 diabetes. Diabetes is one of the major causes of morbidity in Italy, causing several disabilities and affecting the economically active population. The objective of this paper is to identify and discuss costs, outcomes and some of the challenges of diabetes care in Italy in the context of recent policy changes. Methods: The study collected data and evidence from both primary and secondary sources. A total of 10 experts, including clinicians (diabetologists/endocrinologists) and decision makers, both at national and regional levels, were interviewed through face-to-face semi-structured interviews. The secondary sources include peer review literature from Medline, grey literature, reports from national and international sources, including professional bodies and organizations. Results: The total direct cost of diabetes for the Italian NHS in 2012 is estimated to be above €9 billion, of which more than half for hospital admissions (57%), and the remaining half for drugs (30%) and outpatient care (13%). However, there is scant evidence on indirect and intangible costs of diabetes in Italy. The quality of care addressed via the AMD Annals found overall good performance with both process and intermediate outcome indicators showing positive and improving results from 2004 to 2011, except for few parameters, including renal function and foot monitoring, which are still inadequate. Major challenges are the rising diabetes prevalence, the difficulty in meeting the rising demand for care and the scant development of multidisciplinary delivery of care, especially in the predominantly ambulatory setting of the Southern diabetes centres. Conclusions: Prevention of diabetes, especially adopting a multi-sectorial approach, should be further empowered by policy makers through promoting healthy lifestyles and specifically targeting child obesity. Other key strategies include more information and education, better diabetes management through the adoption of a chronic model of care, more focus on appropriateness and efficiency of care and better communication between diabetes centres within every Region

Estudo das propriedades psicométricas da Escala do Empowerment na Diabetes Versão Reduzida (DES-SF)

ABSTRACT - Introduction: The control of diabetes mellitus type 2 implies that people are actively engaged in self-care behaviours and self-efficacy is one of the variables involved in this process. Based on the Model of Behavioural Change, the Diabetes Empowerment Scale assesses the psychosocial self-efficacy of people with this disease. The aim of this study is to analyse the psychometric properties of the Portuguese version of the Diabetes Empowerment Scale (DES-SF), namely its reliability and validity. Method: A methodological nature study was conducted, with a convenience sample comprising 123 participants with diabetes mellitus type 2. In a primary health care context, the participants were asked to fill the DES-SF, the Diabetes Self-care Scale, and a sociodemographic and clinical questionnaire. Four weeks later and in order to evaluate stability over time, the self-efficacy scale was administered to a sub-sample comprised of 23 of these participants. Results: The study showed good internal consistency (Cronbach’s alpha coefficient of 0.83) and stability over time (r = 0.532, p = 0.009) of the DES-SF. The adjustment indices of the confirmatory factor analysis suggested the unidimensional nature of the scale. A positive association was found between self-efficacy and schooling (r = 0.209, p = 0.020), and self-care behaviours, in particular dietary (r = 0.221, p = 0.023) and physical exercise (r = 0.296, p = 0.002). Conclusion: Reliability and validity of the DES-SF was confirmed, which demonstrates its usefulness in the context of clinical practice or in research studies involving the Portuguese population.RESUMO - Introdução: O controlo da diabetes mellitus tipo 2 implica que as pessoas se envolvam ativamente em comportamentos de autocuidado, sendo a autoeficácia uma das variáveis que interfere nesse processo. Baseada no Modelo de Mudança Comportamental a Diabetes Empowerment Scale avalia a autoeficácia psicossocial em pessoas portadoras desta doença. Este estudo tem como objetivo analisar as propriedades psicométricas da versão portuguesa da Escala do Empowerment na Diabetes – versão reduzida (DES-SF), nomeadamente a sua fidelidade e validade. Método: Desenvolvemos um estudo de cariz metodológico, com uma amostra de conveniência de 123 participantes com diabetes mellitus tipo 2 que, em contexto dos cuidados de saúde primários, preencheram a DES-SF, a Escala do Autocuidado na Diabetes e um questionário sociodemográfico e clínico. Para avaliar a estabilidade temporal, a escala da autoeficácia foi novamente preenchida após 4 semanas, por uma subamostra de 23 desses participantes. Resultados: O estudo revelou boa consistência interna (alfa de Cronbach de 0.83) e estabilidade temporal (r = 0.532, p = 0.009) da DES-SF. Os índices de ajustamento, da análise fatorial confirmatória, sugerem a natureza unidimensional da escala. Verificamos uma associação positiva entre a autoeficácia e a escolaridade (r = 0.209, p = 0.020) e os comportamentos de autocuidado, nomeadamente a dieta (r = 0.221, p = 0.023) e o exercício físico (r = 0.296, p = 0.002). Conclusão: A DES-SF revelou ser uma medida fiável e válida, podendo ser utilizado em contexto da prática clínica ou em estudos de investigação, na população portuguesa.info:eu-repo/semantics/publishedVersio