Clinics in Integrated Care最新文献

Polypharmacy is a common clinical issue that affects half of all older adults living in the United States, and it is associated with adverse drug events (ADEs), poor outcomes, unplanned healthcare utilization, and increased healthcare costs. Older adults have a high risk of both polypharmacy and inappropriate medication use given normal changes of aging that influence pharmacokinetics and pharmacodynamics, the presence of multiple medical conditions, and complex treatment regimens used to treat them. Nurses play a key role in reducing polypharmacy and inappropriate medication use in older adults through identification of adverse drug events, promoting the use of nonpharmacological interventions in place of medications, and providing essential patient education to older adults about medications and their side effects.

The long term poor health outcomes in those who have experienced multiple adverse events in childhood have been well documented since the late 1990's. People who have experienced four or more adverse childhood experiences (ACE) are at significantly increased risk of chronic disease as well as mental illness and health risk behaviours. There is growing evidence of the ways in which adversity and toxic stress, cause these poor outcomes. Exposure to adversity has been shown to alter the molecular and genetic makeup of a child as well as changing the way the neurological, immune and endocrine systems develop and function. ACEs are of great public health concern given their long term impact on an individual's health along with the impact on society through economic factors such as loss of productivity and increasing pressure on the healthcare system. Intergenerational and environmental factors have been implicated in perpetuating the cycle of ACEs. Thus, both primary and secondary preventive intervention programmes need to be considered in firstly preventing the occurrence of ACEs and secondly striving to mitigate their ill effects. This article describes the background scientific studies, prevalence and types of risk factors and their effects on human biology and goes on to outline how ACEs contribute to later adult health status and how we might mitigate these through improved primary and secondary prevention.

Management of agitated patients presents a challenge with regard to balancing appropriate diagnostic plans and treatment aimed at controlling symptoms with an interest in prioritizing patient and staff safety and preserving patient dignity. This article will discuss a tiered approach to caring for the agitated patient, including early recognition of escalating behavior, verbal de-escalation techniques, the use and choice of medication and route for symptom control, and concepts related to physical restraint, special populations, and bias.

Interprofessional education interventions are effective at improving the ability of health professionals to work well in teams, to communicate effectively with patients and their families, to respect and appreciate each other's unique and complementary roles in healthcare, and to develop shared values that help sustain collaboration. Yet the definitions and implications of these competencies for telehealth practice need to be clarified. This article reviews and presents the evidence on the development of interprofessional competencies and the implications of these competencies for health professional education. This article also proposes ways in which interprofessional competencies can be incorporated into telehealth practice.

Integrated respiratory care is patient-centred, proactive and coordinated care delivered through clinical leadership and a multidisciplinary ‘team without walls’. It involves rethinking traditional boundaries and roles, and requires respiratory specialists to develop new skills in the management of both acute and long-term conditions through collaborative care. The aim of integrated respiratory care is to enhance the care and experience of the individual patient with a lung condition and to improve long-term outcomes for populations with respiratory disease. Integrated care is a central tenet of how systems will implement the respiratory elements of the NHS Long Term Plan. The COVID-19 pandemic has accelerated the development of integrated care approaches to the multidisciplinary management of acute and chronic respiratory disease.

Bullying is a major public health problem affecting 20% of children in the United States and the United Kingdom. With the proliferation of online electronic and social media use among children, cyberbullying has become more pervasive in recent years and poses its own unique challenges in detection and intervention. Both bullying and cyberbullying cause long-term biological and psychological consequences for all those involved including victims, bully/victims and bullies. Clinicians who treat paediatric patients play a crucial role in not only screening for and addressing the impacts of bullying in their clinical settings, but can also help advocate for evidence-based anti-bullying programs and policies. In addition to clinicians, this issue demands the concerted and coordinated efforts of all those who are concerned with the care of children including teachers, school administrators, educators, and policy makers. This article aims to offer an introduction to identifying and screening for bullying and cyberbullying as well as approaches to addressing these issues in our clinics, schools, and the community at large.

Multimorbidity is associated with advancing age and frailty states. Those with multimorbidity are more likely to have increased morbidity and mortality as well as care needs. Polypharmacy can be problematic in this group with attention required to determine what is appropriate and what is problematic. A distinct approach is necessary to manage multi-morbidity, compared with single organ management. Awareness is required of the relative paucity of evidence-based medicine in this area due to the heterogeneity of combinations of conditions and individual circumstances. Decisions should be made in partnership with the patient living with these conditions and include a dialogue regarding likely benefits and risks of existing management strategies alongside their goals. This article suggests a five step approach to this in the clinic setting. 1) Discussing the purpose of taking multimorbidity specific approach, 2) Establishing disease and treatment burdens, 3) Establishing goals, values and priorities, 4) Review of medications and other treatment and finally 5) Agree an individualized management plan.

This article aims to highlight the areas of care that need improving to support those who are profoundly deaf when attending their appointments. The author has also highlighted suggestions of what could be improved to allow the patient to feel valued but also for them to remain independent.

It became more apparent during the first initial lockdown that there were areas of care missing for these patients and work had been done to try and communicate effectively throughout but that was not always available.

The author has emphasized how communication can be provided effectively while maintaining PPE and social distancing, they have also acknowledged that it can be hard to have confidence in communication and also understanding what is required.

There is discussion around the need for family members and what role they play during the pandemic to help support professionals.

The delivery of care for people with diabetes is a growing challenge with rapid growth in the numbers of people affected and increases in complexity of the management of the disease with more money being spent on diabetes than ever.

The system by which diabetes care is delivered in the UK is often fragmented and involves multiple providers across primary, community and specialist services which are managed by separate organizations, driven by different priorities, outcome measures and budgets, and supported by incompatible IT systems.

To improve the fragmentation of diabetes services, integrated care has been proposed as a solution. In essence, diabetes integration is the whole health community joining in partnership to own the health outcomes of patients with diabetes in their local area. This article examines what integration means to diabetes care, ranging from generalist to specialist diabetes care, describes the five key pillars of the integration of diabetes care and summarises key data sets which can be used.

The COVID-19 pandemic and its restrictions have strained personal psychological resilience, tested family relationships, fragmented local communities, disrupted schools and other educational institutions, exhausted health and social services, and drained national economies. Initial concerns necessarily focused on the ability of primary care services and general hospitals to cope with a potentially overwhelming wave of physically unwell patients. Attention is now being drawn to adverse effects of the pandemic on individual and societal mental health. Mental health services have important roles in mitigating the adverse effects of the pandemic and associated measures such as enforced isolation and regional lockdown on individual mental health, in supporting the recovery of psychologically affected individuals and an exhausted health workforce, and in fostering community resilience and cohesiveness.