611,268 research outputs found

    Medical and nursing students’ co-learning in digitalized health care eco-system

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    The demographic change in Finnish population has forced us to develop digital solutions to meet health care requirements. To respond to the need, we designed and piloted a one-day Multidisciplinary Digital Clinic (MDC) education for medical and nursing students. In this report, we describe our project of the one-day MDC education of digital solutions in primary care for medical and nursing students, and their learning experiences. Additionally, we describe the realization of the intended learning outcomes. The MDC education was conducted by flipped learning method with pre-studying materials. The MDC day was divided into three topical workshops: Remote Care, Digital Symptoms and Health care assessment, and Assessment of Need for care. Students formed three multidisciplinary teams. The students (N=108) valued the opportunity to train with modern technological equipment. Learning in the multidisciplinary teams enabled their knowledge and expertise sharing beyond study field limits, and provided a unique opportunity to discuss together, and thus, helped generate future-proof cooperation skills. The MDC training improved students' understanding of digitally enhanced health care services and increased their understanding of the automated digitalized service pathways, and the continuity of care. In conclusion, the students described MDC as a unique opportunity, and future oriented education. The MDC encouraged students to get involved in the digitally and technologically enhanced health care eco-system in their professional careers

    The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: a qualitative study of Kaiser Permanente.

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    BackgroundPatient portals may lead to enhanced disease management, health plan retention, changes in channel utilization, and lower environmental waste. However, despite growing research on patient portals and their effects, our understanding of the organizational dynamics that explain how effects come about is limited.MethodsThis paper uses qualitative methods to advance our understanding of the organizational dynamics that influence the impact of a patient portal on organizational performance and patient health. The study setting is Kaiser Permanente, the world's largest not-for-profit integrated delivery system, which has been using a portal for over ten years. We interviewed eighteen physician leaders and executives particularly knowledgeable about the portal to learn about how they believe the patient portal works and what organizational factors affect its workings. Our analytical framework centered on two research questions. (1) How does the patient portal impact care delivery to produce the documented effects?; and (2) What are the important organizational factors that influence the patient portal's development?ResultsWe identify five ways in which the patient portal may impact care delivery to produce reported effects. First, the portal's ability to ease access to services improves some patients' satisfaction as well as changes the way patients seek care. Second, the transparency and activation of information enable some patients to better manage their care. Third, care management may also be improved through augmented patient-physician interaction. This augmented interaction may also increase the 'stickiness' of some patients to their providers. Forth, a similar effect may be triggered by a closer connection between Kaiser Permanente and patients, which may reduce the likelihood that patients will switch health plans. Finally, the portal may induce efficiencies in physician workflow and administrative tasks, stimulating certain operational savings and deeper involvement of patients in medical decisions. Moreover, our analysis illuminated seven organizational factors of particular importance to the portal's development--and thereby ability to impact care delivery: alignment with financial incentives, synergy with existing IT infrastructure and operations, physician-led governance, inclusive decision making and knowledge sharing, regional flexibility to implementation, continuous innovation, and emphasis on patient-centered design.ConclusionsThese findings show how organizational dynamics enable the patient portal to affect care delivery by summoning organization-wide support for and use of a portal that meets patient needs

    Power dynamics and knowledge sharing: towards quality holistic dementia care

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    This research explored knowledge sharing among the diverse professionals involved in dementia care. Ageing is an inescapable process in everyone’s life. The ageing process is, however, often accompanied by health and welfare challenges, which require support and attention. A major challenge requiring urgent attention is the increasing prevalence of dementia. Dementia is characterised by the impairment of some brain functions, including memory, understanding and reasoning, which slowly render sufferers incapable of independent living. Consequently, people living with dementia require specialist care that utilises knowledge from disparate groups of aged care experts to make holistically informed decisions to maximise client well-being. Integrating different paradigms of knowledge from diverse professionals involved in dementia care presents a challenge due to the temporal and geographical separation of professionals who often work between facilities and on different schedules. In addition, the professionals and experts have different care responsibilities and expertise. Time and space, as well as differences in responsibilities, make integrating diverse and fragmented knowledge related to holistic client management challenging. The reality is that knowledge is power and, therefore, understanding the power impediments which affect the integration of the diverse knowledge resources in the dementia care system is a valuable area of study. As such, this research stands to inform dementia care providers and ultimately help advance constructive and holistically informed dementia care practice. The research explored the challenges of managing diverse knowledge resources and the associated power dynamics involved in knowledge sharing amongst dementia care teams. This was achieved by examining the knowledge sharing methods among experts, the influence of power dynamics on the knowledge sharing process and how social capital contributes to the relational dynamics among teams of professionals in ways that can either assist or inhibit the sharing of knowledge. The goal of the research was to elucidate the barriers and opportunities for collective knowledge sharing that contributes to holistic dementia care.Thesis (Ph.D.) -- University of Adelaide, Business School, 201

    Health knowledge and care seeking behaviour in resource-limited settings amidst the COVID-19 pandemic: A qualitative study in Ghana

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    Background The emergence of a pandemic presents challenges and opportunities for healthcare, health promotion interventions, and overall improvement in healthcare seeking behaviour. This study explored the impact of COVID-19 on health knowledge, lifestyle, and healthcare seeking behaviour among residents of a resource-limited setting in Ghana. Methods This qualitative study adopted an exploratory design to collect data from 20 adult residents in the Cape Coast Metropolis using face-to-face in-depth interviews. Data collected were analysed thematically and statements from participants presented verbatim to illustrate the themes realised. Results Health knowledge has improved due to COVID–19 in terms of access to health information and increased understanding of health issues. There were reductions in risky health-related lifestyles (alcohol intake, sharing of personal items, and consumption of junk foods) while improvements were observed in healthy lifestyles such as regular physical exercise and increased consumption of fruits and vegetables. COVID–19 also positively impacted health seeking behaviour through increased health consciousness and regular check-ups. However, reduced healthcare utilization was prevalent. Conclusion The COVID–19 pandemic has presented a positive cue to action and helped improved health knowledge, lifestyle, and care seeking behaviour although existing health system constrains and low economic status reduced healthcare utilization. To improve health systems, health-related lifestyles and healthcare seeking behaviour as well as overall health outcomes even after the pandemic wades off, COVID–19 associated conscious and unconscious reforms should be systematically harnessed

    Wide-scale continuous quality improvement: A study of stakeholders' use of quality of care reports at various system levels, and factors mediating use

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    © 2019 Laycock, Bailie, Percival, Matthews, Cunningham, Harvey, Copley, Patel and Bailie. Introduction: Increasing the use of evidence in healthcare policy and practice requires greater understanding of how stakeholders use evidence to inform policy, refine systems and change practice. Drawing on implementation theory, we have used system-focused participatory research to engage diverse stakeholders in using aggregated continuous quality improvement (CQI) data from Australian Indigenous primary health care settings to identify priority evidence-practice gaps, barriers/enablers and strategies for improvement. This article reports stakeholders' use or intended use of evidence at various levels of the system, and factors mediating use. Material and Methods: Interviews were undertaken with a purposeful sample of 30 healthcare stakeholders in different roles, organization types and settings in one Australian jurisdiction and with national participants, as part of the project's developmental evaluation. Qualitative data were analyzed to identify themes and categories relating to use of evidence. Results: Context-specific aggregated CQI data that were relatable to the diverse professional roles and practices provided an effective starting point for sharing perspectives, generating practice-based evidence and mobilizing evidence-use. Interviewees perceived the co-produced findings as applicable at different levels and useful for planning, policy development, supporting best practice and reflection, capacity strengthening and developing new research. Factors mediating use were commitment to best practice; the credibility of the evidence and its perceived relevance to work roles, contexts and decision needs; report format and language; facilitation and communication; competing work pressures and the organizational environment for change. Conclusions: This study found that primary health care stakeholders used evidence on quality of care for a variety of purposes. This could be linked to the interactive research processes used to engage stakeholders in different roles and settings in interpreting data, sharing and generating knowledge. Findings indicate that system-based participatory research using CQI data and iterative, interactive and systematic CQI-based methods can be applied at scale to support concurrent action for healthcare improvement at different system levels. Factors known to influence implementation should be addressed within the research design to optimize evidence use. Further research is needed to explore the utility of interactive dissemination for engaging healthcare stakeholders in informing policy and system change

    ‘Maybe we can turn the tide’ : an explanatory mixed-methods study to understand how knowledge brokers mobilise health evidence in low- and middle-income countries

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    Background: Little is known about how knowledge brokers (KBs) operate in low- and middle-income countries (LMICs) to translate evidence for health policy and practice. These intermediaries facilitate relationships between evidence producers and users to address public health issues. Aims and objectives: To increase understanding, a mixed-methods study collected data from KBs who had acted on evidence from the 2015 Global Maternal Newborn Health Conference in Mexico. Methods: Of the 1000 in-person participants, 252 plus 72 online participants (n=324) from 56 countries completed an online survey, and 20 participants from 15 countries were interviewed. Thematic analysis and application of knowledge translation (KT) theory explored factors influencing KB actions leading to evidence uptake. Descriptive statistics of respondent characteristics were used for cross-case comparison. Findings: Results suggest factors supporting the KB role in evidence uptake, which include active relationships with evidence users through embedded KB roles, targeted and tailored evidence communication to fit the context, user receptiveness to evidence from a similar country setting, adaptability in the KB role, and action orientation of KBs. Discussion and conclusions: Initiatives to increase evidence uptake in LMICs should work to establish supportive structures for embedded KT, identify processes for ongoing cross-country learning, and strengthen KBs already showing effectiveness in their roles

    Strengthening Pharmacovigilance System to Capture Safety Data from HIV Clients on ART in Tanzania: Identification of Gaps in Safety Reporting System

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    In Tanzania, pharmacovigilance system is implemented by Tanzania Food and Drugs Authority (TFDA) that monitors drug use countrywide. TFDA is the main national custodian for recording, analyzing and disseminating safety information that is generated through conventional health care facilities. Since the introduction of Care and Treatment Centre (CTC) in the health care system, little has been achieved on translating safety information from these facilities to the TFDA. Since the inception of national pharmacovigilance framework in 2003 there has been no systematic operational research to map the gaps in the existing pharmacovigilance system. Furthermore, it is not clear if there is adequate training and supervision. It is, therefore, important to strengthen antiretroviral therapy (ART) related adverse drug reactions (ADRs) reporting by mapping gaps in implementation of pharmacovigilance (PV) system. Information obtained will assist in addressing training needs to ensure effective reporting of ADRs through coordinated approach involving TFDA and National AIDS Control Program (NACP) in Tanzania. A cross-sectional study was conducted in four regions (Tanga, Singida, Dodoma and Mtwara) in two PV zones. Qualitative and quantitative data collection techniques with triangulation design were used. These included; desk document review of PV recording and reporting of drug safety information; in-depth interviews with various implementation stakeholders, exit interviews with patients, in-interviews with care takers and community based organizations (CBOs) involved in the provision of care and treatment of HIV/AIDS. A total of 801 respondents participated in the quantitative data component which included; 545 exit interviews to CTC clients, 177 health service providers, 62 in-depth interviews to CTC in-charges and 17 regional and district pharmacists. Ownership of these CTCs included 83.9% government, 12.9% faith based organizations and 3.2% co-owned by the government and faith based organizations. High proportions (97.2%) of the CTC health care providers had wide knowledge on ART related ADRs. However, more than half (53.4%) of the CTC service providers had not attended any training on ART related ADRs. Among the service providers, majority (67.8%) mentioned there was no guideline in place for reporting ART related ADRs. Only, 32.1% of health care providers indicated to be aware of the tool used for collection of ART related ADRs events. Of those, 37.5% mentioned that the forms were mainly obtained from district or regional pharmacists. The ADR reports were submitted to district and regional pharmacists 48.3%, TFDA 7.0%, and NACP 7.0%. Of those who indicated to have filled and submitted ADR form, only 7.4% received feedback. The proportion of ART clients who provided information was significantly different between urban and rural in Dodoma region (p=0.002). There was variation in proportions of ART clients who had mentioned seen/heard of ART related ADR by regions and difference was significant between rural and urban for all regions except Tanga (p<0.05). Majority (47.9%) of the ART clients reported ART related ADRs to the health provider for duration ranging from 3-7 days. The qualitative results revealed that that most of the guidelines from TFDA were not known and unavailable according to most of the respondents at national level (NACP), regional, district, and at health facility level. It was surprising that one of the district pharmacists interviewed was unaware of existence of guidelines in place for ADR and PV for use in the districts. It was also found that Sometimes even when available at health facilities, there was inadequate knowledge on how to fill the ADR forms according to Key Informant at national level. Moreover, several health workers admitted that that they were not reporting ADR due to a lack of forms according to some CTC in-charges interviewed. This study has shown that despite the established PV system in Tanzania, the frequency of reporting of ART related ADRs to TFDA is low. This is due to inadequate training of health care providers on ADR reporting, shortage of staff, unavailability of TFDA ADR reporting forms and lack of regular supportive supervision. Based on these results therefore we recommend TFDA should ensure that ADR reporting forms as well as guidelines are adequately supplied and utilized at CTC level NACP should ensure sharing of safety information with TFDA and recommend dedicated focal person liable for documenting and reporting ART related ADRs recorded in CTC II patient file. Regular training, supportive supervision and feedback on ART related ADR reporting system for health care providers is needed. The financial support was provided by the Global Fund Round 8. The total budget for the project was Tsh. 69,993,000/-

    Creating a More Collaborative Tomorrow: Development of a Patient Engagement Curriculum for a School of Nursing and Health Professions

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    Background: Healthcare has been moving steadily toward a patient-centered paradigm that seeks to involve patients more in their own care. Teaching communication skills to future health professionals can increase such patient participation. Despite the shift to patient-centered care, there is almost no training in patient engagement techniques provided to students at the University of San Francisco School of Nursing and Health Professions. Purpose: This project aimed to design and develop a sustainable patient engagement curriculum that meets the unique needs of faculty and students at the University. Methods: Interviews were conducted with eight faculty members to understand the best format, timing, and content for the curriculum. A course with modules covering patient engagement techniques was created in a learning management system (LMS), which allows faculty to modify and import modules into their own existing courses. The modules cover the concepts of patient engagement, shared decision making, health coaching, decision aids, common communication barriers, and cultural competence. Results: Faculty who reviewed the course were overwhelmingly positive, because the modules meet their need for a combination of online didactics and in-person simulations that are easily accessed, modified, and merged with existing courses. Students who attended two pilot in-person workshops wanted greater variety in simulation scenarios but reported a better understanding of patient engagement and comfort with sharing decisions with patients. Conclusions: Using an LMS to distribute learning modules about patient engagement techniques may help faculty build student knowledge over time and create opportunities for interprofessional training

    Opportunities for information sharing: case studies

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    Personal information provided to government and non-government service providers is highly sensitive. Appropriate collection, management and storage of personal information are critical elements to citizen trust in the public sector. However, misconceptions about the frameworks governing sharing personal information can impact on the coordination of services, case management and policy development. &nbsp; The NSW Department of Premier &amp; Cabinet engaged the Social Policy Research Centre to develop three case studies that identified the challenges to sharing information appropriately, and the opportunities for better personal information sharing between government agencies and non-government organisations. Improved sharing of personal information in these areas can support more effective policy development, leading to improved service delivery performance and coordination. &nbsp; The Social Policy Research Centre identified the legislative and policy framework for each case study, conducted qualitative research on the interpretation of this framework, and developed three case study reports
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