Pub Date : 2022-01-05DOI: 10.1177/20534345211070652
Hanna Kallio, A. Häggman-Laitila, Reetta Saarnio, L. Viinamäki, M. Kangasniemi
Introduction Client orientation is an essential principle that underlines the delivery of high-quality health and social care. Despite this, little is known about how the health and social care professionals perceive this principle. The aim of this qualitative study was to describe the integrated perceptions of health and social care professionals of client orientation and the requirements for competencies and care and service systems. Methods The 29 participants were Finnish health and social care professionals and the data were collected with asynchronous online discussions in a closed Internet-based group from November 2017 to January 2018 and analysed with inductive content analysis. Results Client orientation was a core value in health and social care and services due to the humane approach required and the client's rights and responsibilities. It also required the professionals to have specific competencies and collaborate. The system elements that supported client orientation were an integrating and responsive service system, service availability and accessibility, guidance, leadership, resources and the effective use of technology. Discussion Professionals need additional training and structural support from their organizations if they were to deliver efficient, flexible, high-quality client-oriented health and social care and services.
{"title":"Working towards integrated client-oriented care and services: A qualitative study of the perceptions of Finnish health and social care professionals","authors":"Hanna Kallio, A. Häggman-Laitila, Reetta Saarnio, L. Viinamäki, M. Kangasniemi","doi":"10.1177/20534345211070652","DOIUrl":"https://doi.org/10.1177/20534345211070652","url":null,"abstract":"Introduction Client orientation is an essential principle that underlines the delivery of high-quality health and social care. Despite this, little is known about how the health and social care professionals perceive this principle. The aim of this qualitative study was to describe the integrated perceptions of health and social care professionals of client orientation and the requirements for competencies and care and service systems. Methods The 29 participants were Finnish health and social care professionals and the data were collected with asynchronous online discussions in a closed Internet-based group from November 2017 to January 2018 and analysed with inductive content analysis. Results Client orientation was a core value in health and social care and services due to the humane approach required and the client's rights and responsibilities. It also required the professionals to have specific competencies and collaborate. The system elements that supported client orientation were an integrating and responsive service system, service availability and accessibility, guidance, leadership, resources and the effective use of technology. Discussion Professionals need additional training and structural support from their organizations if they were to deliver efficient, flexible, high-quality client-oriented health and social care and services.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47815470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-29DOI: 10.1177/20534345211070653
Brandy Shook, Cara Palusak, S. Davies, Jennifer P. Lundine
Introduction & importance Children with traumatic brain injury (TBI) report unmet needs several years after their injury and may require long-term care. However, this chronic health condition is often only treated and monitored in the short-term. Care for young persons with TBI often relies on parents to manage their child's complex care network. Effective care coordination can close these gaps and facilitate continuity of care for children with TBI. The purpose of this scoping review was to develop a better understanding of tools that improve care coordination for Children with Special Health Care Needs (CSHCN). This, in turn, can inform care for children with TBI. Methods A scoping review was conducted following the PRISMA framework and methodology. OVID/Medline, CINAHL, PsycINFO, EMBASE, and ERIC databases were searched for articles relevant to care coordination tools used with CSHCN. Results 21 articles met the criteria for inclusion in the review, and 6 major categories of care coordination tools were identified: telehealth, online health records and tools, care plans, inpatient discharge protocols, family training, and reminders. Discussion Studies examining telehealth, online tools, care plans, and family training care coordination interventions for CSHCN have shown positive outcomes and would be relevant strategies to improve the care of children with TBI. Future prospective research should investigate these tools to explore whether they might improve communication, reduce unmet needs, increase service access, and improve long-term outcomes for children with TBI.
{"title":"A scoping review to inform care coordination strategies for youth with traumatic brain injuries: Care coordination tools","authors":"Brandy Shook, Cara Palusak, S. Davies, Jennifer P. Lundine","doi":"10.1177/20534345211070653","DOIUrl":"https://doi.org/10.1177/20534345211070653","url":null,"abstract":"Introduction & importance Children with traumatic brain injury (TBI) report unmet needs several years after their injury and may require long-term care. However, this chronic health condition is often only treated and monitored in the short-term. Care for young persons with TBI often relies on parents to manage their child's complex care network. Effective care coordination can close these gaps and facilitate continuity of care for children with TBI. The purpose of this scoping review was to develop a better understanding of tools that improve care coordination for Children with Special Health Care Needs (CSHCN). This, in turn, can inform care for children with TBI. Methods A scoping review was conducted following the PRISMA framework and methodology. OVID/Medline, CINAHL, PsycINFO, EMBASE, and ERIC databases were searched for articles relevant to care coordination tools used with CSHCN. Results 21 articles met the criteria for inclusion in the review, and 6 major categories of care coordination tools were identified: telehealth, online health records and tools, care plans, inpatient discharge protocols, family training, and reminders. Discussion Studies examining telehealth, online tools, care plans, and family training care coordination interventions for CSHCN have shown positive outcomes and would be relevant strategies to improve the care of children with TBI. Future prospective research should investigate these tools to explore whether they might improve communication, reduce unmet needs, increase service access, and improve long-term outcomes for children with TBI.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2021-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46514468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-28DOI: 10.1177/20534345211068300
J. Medves, G. Paré, Kimberly Woodhouse, Carol Smith-Romeril, Wenbin Li, J. Tranmer
Introduction Continuity of care by family physicians in primary care settings may play a role in reducing health resource utilization and improving clinical outcomes and satisfaction of patients with chronic obstructive pulmonary disease. Clear evidence on the impact of continuity of care will support clinical programing and integration of services across health settings. Methods The association between continuity of care and unplanned health service utilization in persons with a diagnosis of chronic obstructive pulmonary disease in a rural region in Ontario, Canada was evaluated. A retrospective cohort study was conducted using population-level health administrative data. The main exposure variable was continuity of care. Results A continuity of care index was calculated for patients with at least five visits to a healthcare provider during the 5-year follow-up period (n = 40,033). Higher continuity of care (n = 20,008) and lower continuity of care (n = 20,025), based on the median continuity of care score were calculated. Patients with lower continuity of care had an increased adjusted relative risk of 2.12 (2.08, 2.33) of an emergency department visit, 2.81 (2.72, 2.9) risk of hospitalization, and 3.52 (3.24, 3.82) of being readmitted to hospital compared to those with higher continuity of care. Discussion An association between continuity of care and unplanned health services utilization, where a lower use of unplanned health services was observed in the cohort of patients with chronic obstructive pulmonary disease experiencing higher continuity of care. Continuity of care makes philosophical and social sense in that care is provided by a known provider to a known patient and unnecessary investigations can be avoided.
{"title":"The case for continuity of care for people with chronic obstructive pulmonary disease","authors":"J. Medves, G. Paré, Kimberly Woodhouse, Carol Smith-Romeril, Wenbin Li, J. Tranmer","doi":"10.1177/20534345211068300","DOIUrl":"https://doi.org/10.1177/20534345211068300","url":null,"abstract":"Introduction Continuity of care by family physicians in primary care settings may play a role in reducing health resource utilization and improving clinical outcomes and satisfaction of patients with chronic obstructive pulmonary disease. Clear evidence on the impact of continuity of care will support clinical programing and integration of services across health settings. Methods The association between continuity of care and unplanned health service utilization in persons with a diagnosis of chronic obstructive pulmonary disease in a rural region in Ontario, Canada was evaluated. A retrospective cohort study was conducted using population-level health administrative data. The main exposure variable was continuity of care. Results A continuity of care index was calculated for patients with at least five visits to a healthcare provider during the 5-year follow-up period (n = 40,033). Higher continuity of care (n = 20,008) and lower continuity of care (n = 20,025), based on the median continuity of care score were calculated. Patients with lower continuity of care had an increased adjusted relative risk of 2.12 (2.08, 2.33) of an emergency department visit, 2.81 (2.72, 2.9) risk of hospitalization, and 3.52 (3.24, 3.82) of being readmitted to hospital compared to those with higher continuity of care. Discussion An association between continuity of care and unplanned health services utilization, where a lower use of unplanned health services was observed in the cohort of patients with chronic obstructive pulmonary disease experiencing higher continuity of care. Continuity of care makes philosophical and social sense in that care is provided by a known provider to a known patient and unnecessary investigations can be avoided.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2021-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49417586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.1177/20534345211063482
K. Kokorelias, Stephanie Posa, T. DasGupta, Naomi Ziegler, S. Hitzig
Introduction The success of new patient navigation programs have mostly been described from the perspectives of patient outcomes. Little is known about how patient navigators interact with healthcare professionals in the community and in hospital settings. Methods A qualitative study using a phenomenological analysis was undertaken to depict the lived experiences of Ontario (Canada) healthcare providers who have interacted with a patient navigator. Semi-structured interviews were conducted with 42 healthcare professionals, including frontline care providers (n = 25) and administrators (n = 16) from hospital (n = 21) and community care settings (n = 21). Results Participants’ experiences were reflected in one overarching theme: role clarity and three emergent themes related to the overarching theme: (i) concerns over accountability of patient care (ii) trust (iii) attainable-but-not. Participants described an inconsistent understanding of the role of patient navigators which led to uncertainty regarding their role in patient care. The current nature of the healthcare system influenced participants’ belief in the sustainability of patient navigation model of care. Despite these experiences, participants felt that patient navigators could help healthcare providers care for patients by preventing potential crises from developing and enhancing their knowledge about services. Discussion This study expands our understanding of patient navigation programs by exploring the experiences and perceptions of healthcare professionals, thereby providing new perspectives into components that support the successful health outcomes of older adults being supported by a patient navigator. The implications of findings for research, clinical practice, and policy are described.
{"title":"“I think like if Albert Einstein and Superman had a baby, that's what it would take”: The experiences and perceptions of community and hospital healthcare professionals in a seniors’ patient navigator program","authors":"K. Kokorelias, Stephanie Posa, T. DasGupta, Naomi Ziegler, S. Hitzig","doi":"10.1177/20534345211063482","DOIUrl":"https://doi.org/10.1177/20534345211063482","url":null,"abstract":"Introduction The success of new patient navigation programs have mostly been described from the perspectives of patient outcomes. Little is known about how patient navigators interact with healthcare professionals in the community and in hospital settings. Methods A qualitative study using a phenomenological analysis was undertaken to depict the lived experiences of Ontario (Canada) healthcare providers who have interacted with a patient navigator. Semi-structured interviews were conducted with 42 healthcare professionals, including frontline care providers (n = 25) and administrators (n = 16) from hospital (n = 21) and community care settings (n = 21). Results Participants’ experiences were reflected in one overarching theme: role clarity and three emergent themes related to the overarching theme: (i) concerns over accountability of patient care (ii) trust (iii) attainable-but-not. Participants described an inconsistent understanding of the role of patient navigators which led to uncertainty regarding their role in patient care. The current nature of the healthcare system influenced participants’ belief in the sustainability of patient navigation model of care. Despite these experiences, participants felt that patient navigators could help healthcare providers care for patients by preventing potential crises from developing and enhancing their knowledge about services. Discussion This study expands our understanding of patient navigation programs by exploring the experiences and perceptions of healthcare professionals, thereby providing new perspectives into components that support the successful health outcomes of older adults being supported by a patient navigator. The implications of findings for research, clinical practice, and policy are described.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49015900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.1177/20534345211068094
Taylor A Kobussen, G. Hansen, Tanya R Holt
Introduction Pediatric complex chronic care patients present unique challenges regarding healthcare provision: complex medical regimes, complicated family/provider dynamics, and multiple healthcare teams that can result in inconsistent care. This study examined subspecialty providers’ perspectives regarding pediatric complex chronic care patients and compared them with acute care providers while exploring opportunities to better facilitate care provided to pediatric complex chronic care patients. Methods This survey study occurring within a Canadian tertiary care pediatric center, utilized REDCap to deploy surveys involving Likert Scale and short answer questions. The Kruskal–Wallis test compared subspecialty provider perspectives when providing care to pediatric complex chronic care patients versus non-pediatric complex chronic care patients; and perspectives between subspecialty and acute care providers. Results Survey response rate was 24/46 (52.2%). Eight overarching themes emerged from Likert scale questions. Short answer questions revealed factors that may facilitate care provided to pediatric complex chronic care patients: access to funding; discharge planning; communication methods between specialists; and healthcare provider continuity. Several differences were identified when working with pediatric complex chronic care patients, compared to non-pediatric complex chronic care patients: increased time/resource burden; managing expectations of patients/families; navigating discrepancies in goals of care; complexity of coordination between services; increased efforts in coordinating discharge from hospital and working with medicalized patients/families. Discussion Exploring pediatric subspecialty provider perspectives of pediatric complex chronic care patients revealed opportunities to enhance care provided: increased resources to ease the strain of care provision for parents, implementation of a discharge coordinator, complex care clinics with a pediatrician to “quarterback” care, and co-management between the complex care pediatrician and acute care physician when admitted to an acute care service. Implementation of these initiatives may improve the care provided to pediatric complex chronic care patients.
{"title":"Comparing subspecialty and intensive care providers perspectives on pediatric complex chronic patients: A survey study","authors":"Taylor A Kobussen, G. Hansen, Tanya R Holt","doi":"10.1177/20534345211068094","DOIUrl":"https://doi.org/10.1177/20534345211068094","url":null,"abstract":"Introduction Pediatric complex chronic care patients present unique challenges regarding healthcare provision: complex medical regimes, complicated family/provider dynamics, and multiple healthcare teams that can result in inconsistent care. This study examined subspecialty providers’ perspectives regarding pediatric complex chronic care patients and compared them with acute care providers while exploring opportunities to better facilitate care provided to pediatric complex chronic care patients. Methods This survey study occurring within a Canadian tertiary care pediatric center, utilized REDCap to deploy surveys involving Likert Scale and short answer questions. The Kruskal–Wallis test compared subspecialty provider perspectives when providing care to pediatric complex chronic care patients versus non-pediatric complex chronic care patients; and perspectives between subspecialty and acute care providers. Results Survey response rate was 24/46 (52.2%). Eight overarching themes emerged from Likert scale questions. Short answer questions revealed factors that may facilitate care provided to pediatric complex chronic care patients: access to funding; discharge planning; communication methods between specialists; and healthcare provider continuity. Several differences were identified when working with pediatric complex chronic care patients, compared to non-pediatric complex chronic care patients: increased time/resource burden; managing expectations of patients/families; navigating discrepancies in goals of care; complexity of coordination between services; increased efforts in coordinating discharge from hospital and working with medicalized patients/families. Discussion Exploring pediatric subspecialty provider perspectives of pediatric complex chronic care patients revealed opportunities to enhance care provided: increased resources to ease the strain of care provision for parents, implementation of a discharge coordinator, complex care clinics with a pediatrician to “quarterback” care, and co-management between the complex care pediatrician and acute care physician when admitted to an acute care service. Implementation of these initiatives may improve the care provided to pediatric complex chronic care patients.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44587374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.1177/20534345211068674
H. Vrijhoef
Existing health inequalities have been brought to the fore by the COVID-19 pandemic. Investing in the conditions that improve people’s health (i.e., education, employment, housing, social networks, healthy environment) should be an essential part of the COVID-19 recovery for societies. The UK government has set out to ‘level up the nation’s health’. In their briefing ‘A whole government approach to improving health’, Merrifield & Nightingale call for continued action from across the whole of government and beyond. They argue that such action is needed both through how government organizes itself to deliver impact and through pursuing the policies that will make a real difference. Acknowledging that health improvement is the responsibility of a range of departments, not just the Department of Health and Social Care, requires all departments to understand the health implications of the decisions they make and the costings involved. Important lessons regarding policies that will make a real difference as part of this movement could be taken from Miller’s et al. overview of integrated care policy in England from 2010 to 2020. They argue that ‘English health and social care services were simply not designed as a system or with integration in mind.’ In yet another analysis of three national programmes piloting integrated care in England, Lewis et al. question ‘why the debate about how best to integrate health and social care remains unfinished business’. In discussing the ambiguous conceptualization of integrated care, they point out the importance of focusing ‘not on what is done within what organisational construct, but on what patients and carers consider to be needed and what will best support care workers of all sorts to work effectively together’. If some systems are unable to be integrated because they simply do not fit together, then perhaps coordination is a more realistic strategy to level up a nation’s health. Health coordination should become the new standard, with care coordination and integration as supporting strategies, if and where appropriate. By bridging the human and its supporting system, health coordinators make use of what works and are well positioned to identify what hinders health improvement. In this light, narrowly focused approaches such as ‘integrated primary care’ and ‘integrated diabetes care’ do not seem sustainable strategies. A redistribution of resources away from disease-oriented or sector-focused policies in the direction of a broad health ecosystem is urgently needed to make a real impact. In this double issue of the International Journal of Care Coordination, van Tuyl et al. report on a scoping review of international literature about task-shifting expert interviews and in-depth analysis of five task-shifting cases in the Netherlands. They discuss that only when designed to face specific complexities at the workplace and taking into account the balance between specialists and generalists, task shifting may substa
{"title":"Changing perspectives: From care coordination to health coordination","authors":"H. Vrijhoef","doi":"10.1177/20534345211068674","DOIUrl":"https://doi.org/10.1177/20534345211068674","url":null,"abstract":"Existing health inequalities have been brought to the fore by the COVID-19 pandemic. Investing in the conditions that improve people’s health (i.e., education, employment, housing, social networks, healthy environment) should be an essential part of the COVID-19 recovery for societies. The UK government has set out to ‘level up the nation’s health’. In their briefing ‘A whole government approach to improving health’, Merrifield & Nightingale call for continued action from across the whole of government and beyond. They argue that such action is needed both through how government organizes itself to deliver impact and through pursuing the policies that will make a real difference. Acknowledging that health improvement is the responsibility of a range of departments, not just the Department of Health and Social Care, requires all departments to understand the health implications of the decisions they make and the costings involved. Important lessons regarding policies that will make a real difference as part of this movement could be taken from Miller’s et al. overview of integrated care policy in England from 2010 to 2020. They argue that ‘English health and social care services were simply not designed as a system or with integration in mind.’ In yet another analysis of three national programmes piloting integrated care in England, Lewis et al. question ‘why the debate about how best to integrate health and social care remains unfinished business’. In discussing the ambiguous conceptualization of integrated care, they point out the importance of focusing ‘not on what is done within what organisational construct, but on what patients and carers consider to be needed and what will best support care workers of all sorts to work effectively together’. If some systems are unable to be integrated because they simply do not fit together, then perhaps coordination is a more realistic strategy to level up a nation’s health. Health coordination should become the new standard, with care coordination and integration as supporting strategies, if and where appropriate. By bridging the human and its supporting system, health coordinators make use of what works and are well positioned to identify what hinders health improvement. In this light, narrowly focused approaches such as ‘integrated primary care’ and ‘integrated diabetes care’ do not seem sustainable strategies. A redistribution of resources away from disease-oriented or sector-focused policies in the direction of a broad health ecosystem is urgently needed to make a real impact. In this double issue of the International Journal of Care Coordination, van Tuyl et al. report on a scoping review of international literature about task-shifting expert interviews and in-depth analysis of five task-shifting cases in the Netherlands. They discuss that only when designed to face specific complexities at the workplace and taking into account the balance between specialists and generalists, task shifting may substa","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47500344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.1177/20534345211067620
Chidiogo Anyigbo, Anne E Fuller, Yao I Cheng, Linda Y Fu, Harolyn M Belcher, Beth A Tarini, Nicole M Brown
Introduction: Children exposed to adverse childhood experiences (ACEs) may access multiple systems of care to address medical and social complexities. Care coordination (CC) optimizes health outcomes for children with special health care needs who often use multiple systems of care. Little is known about whether ACEs are associated with need and unmet need for CC.
Methods: Use of the 2016-2017 National Survey of Children's Health to identify children who saw ≥1 health care provider in the last 12 months. The study team used weighted logistic regression analyses to examine associations between 9 ACE types, ACE score and need and unmet need for CC.
Results: In the sample (N=39,219, representing 38,316,004 US children), material hardship (aOR, 1.50; 95% CI, 1.29-1.75), parental mental illness (aOR, 1.31; 95% CI, 1.07-1.60), and neighborhood violence (aOR, 1.33; 95% CI, 1.01-1.74) were significantly associated with an increased need for CC. Material hardship was also associated with unmet need for CC (aOR, 2.37; 95% CI, 1.80 - 3.11). Children with ACE scores of 1, 2, 3, and ≥4 had higher odds of need and unmet need for CC than children with 0 ACEs.
Discussion: Specific ACE types and higher ACE scores were associated with need and unmet need for CC. Evaluating the unique needs of children who endured ACEs should be considered in the design and implementation of CC processes in the pediatric healthcare system.
{"title":"Associations between Adverse Childhood Experiences and Need and Unmet Need for Care Coordination.","authors":"Chidiogo Anyigbo, Anne E Fuller, Yao I Cheng, Linda Y Fu, Harolyn M Belcher, Beth A Tarini, Nicole M Brown","doi":"10.1177/20534345211067620","DOIUrl":"https://doi.org/10.1177/20534345211067620","url":null,"abstract":"<p><strong>Introduction: </strong>Children exposed to adverse childhood experiences (ACEs) may access multiple systems of care to address medical and social complexities. Care coordination (CC) optimizes health outcomes for children with special health care needs who often use multiple systems of care. Little is known about whether ACEs are associated with need and unmet need for CC.</p><p><strong>Methods: </strong>Use of the 2016-2017 National Survey of Children's Health to identify children who saw ≥1 health care provider in the last 12 months. The study team used weighted logistic regression analyses to examine associations between 9 ACE types, ACE score and need and unmet need for CC.</p><p><strong>Results: </strong>In the sample (N=39,219, representing 38,316,004 US children), material hardship (aOR, 1.50; 95% CI, 1.29-1.75), parental mental illness (aOR, 1.31; 95% CI, 1.07-1.60), and neighborhood violence (aOR, 1.33; 95% CI, 1.01-1.74) were significantly associated with an increased need for CC. Material hardship was also associated with unmet need for CC (aOR, 2.37; 95% CI, 1.80 - 3.11). Children with ACE scores of 1, 2, 3, and ≥4 had higher odds of need and unmet need for CC than children with 0 ACEs.</p><p><strong>Discussion: </strong>Specific ACE types and higher ACE scores were associated with need and unmet need for CC. Evaluating the unique needs of children who endured ACEs should be considered in the design and implementation of CC processes in the pediatric healthcare system.</p>","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8903198/pdf/nihms-1781079.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10408263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.1177/20534345211061032
Stuti M. Tanya, Bonnie He, Christine Aubrey-Bassler
Introduction Vision health is an important and underutilized health service among newly arrived refugees in Canada, yet the body of literature on eye-care delivery in this population is limited. The study objective was to identify patterns of eye-care utilization among refugee patients with type 2 diabetes mellitus (T2DM) in Newfoundland and Labrador (NL) under an interdisciplinary clinic model comprised of family physicians, eye-care providers, and settlement services. Methods This was a retrospective cohort study at the Memorial University Family Medicine clinic. All patients with a new T2DM diagnosis between 2015–2020 were included. Data were described using basic statistics and unpaired t-tests. This study received full ethics approval. Results Seventy-three (18 refugee, 55 non-refugee) patients were included. Refugees had a higher rate of referral to an eye-care provider (p = 0.0475) and were more likely to attend their eye-care provider appointment than non-refugees (p = 0.016). The time from diagnosis to referral was longer for refugees than non-refugees (p = 0.0498). A trend towards longer time from referral to appointment attendance for refugees than non-refugees was noted (p = 0.9069). Discussion Refugee patients had higher rates of referral to eye-care providers and utilization of eye-care services. However, refugees also experienced a longer time to access vision screening services suggesting possible gaps in accessible care delivery. This suggests that the interdisciplinary model of care may be effective in referring refugee patients for vision screening and there may be a role for increased collaboration across family physicians, eye-care providers, and settlement services to improve accessibility of vision screening services.
{"title":"Eye-care utilization among a Canadian diabetic refugee population: retrospective cohort study of an interdisciplinary care model","authors":"Stuti M. Tanya, Bonnie He, Christine Aubrey-Bassler","doi":"10.1177/20534345211061032","DOIUrl":"https://doi.org/10.1177/20534345211061032","url":null,"abstract":"Introduction Vision health is an important and underutilized health service among newly arrived refugees in Canada, yet the body of literature on eye-care delivery in this population is limited. The study objective was to identify patterns of eye-care utilization among refugee patients with type 2 diabetes mellitus (T2DM) in Newfoundland and Labrador (NL) under an interdisciplinary clinic model comprised of family physicians, eye-care providers, and settlement services. Methods This was a retrospective cohort study at the Memorial University Family Medicine clinic. All patients with a new T2DM diagnosis between 2015–2020 were included. Data were described using basic statistics and unpaired t-tests. This study received full ethics approval. Results Seventy-three (18 refugee, 55 non-refugee) patients were included. Refugees had a higher rate of referral to an eye-care provider (p = 0.0475) and were more likely to attend their eye-care provider appointment than non-refugees (p = 0.016). The time from diagnosis to referral was longer for refugees than non-refugees (p = 0.0498). A trend towards longer time from referral to appointment attendance for refugees than non-refugees was noted (p = 0.9069). Discussion Refugee patients had higher rates of referral to eye-care providers and utilization of eye-care services. However, refugees also experienced a longer time to access vision screening services suggesting possible gaps in accessible care delivery. This suggests that the interdisciplinary model of care may be effective in referring refugee patients for vision screening and there may be a role for increased collaboration across family physicians, eye-care providers, and settlement services to improve accessibility of vision screening services.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47241755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.1177/20534345211061677
B. Yanti, Nurdarlila Armita, I. Zakaria
Introduction Health workers are at high risk of contracting the disease because they are at the forefront of assisting COVID19 patients. Globally, Indonesia has the worst death toll of health workers. Many previous studies have shown the differences in knowledge, attitudes, and behavior of health workers in handling with the COVID19 pandemic. This study aims to asses the role of knowledge, attitudes, and health workers' preparedness during the COVID-19 pandemic in Aceh Pidie Jaya District. Methods A cross-sectional study and the data were collected by distributing online questionnaires about knowledge, attitudes, behavior, and preparedness related to the COVID-19 at 12 Pidie Jaya District health centers. The knowledge, behavior, and preparedness parameters used Guttman and Likert scales to measure the workers' attitudes. Chi-square test was used to evaluate the relationship between knowledge, attitudes, behavior, and preparedness. Results In this study, 377 health workers were selected, the majority of respondents' education level was diploma, level 3 (257, 76.3%), and one-third of the respondents did not attend training. There are 197 (58.5%) respondents who had good knowledge, 177 (52.5%) positive attitudes, 283 (84%) good behavior, and 173 (51, 3%) well prepared. Furthermore, good knowledge, positive attitude, and good behavior had a significant correlation statistically with well prepared during the pandemic (p < 0.05). Discussion Most of the health workers in Aceh Pidie Jaya have good knowledge, positive attitudes, and good behavior that create adequate preparedness. Even though training is still very limited, educational attainment would remain the cornerstone for preparedness to encounter COVID-19.
{"title":"The role of knowledge, attitudes, and health workers’ behavior in COVID19 pandemic preparedness at Aceh Pidie Jaya District, Indonesia","authors":"B. Yanti, Nurdarlila Armita, I. Zakaria","doi":"10.1177/20534345211061677","DOIUrl":"https://doi.org/10.1177/20534345211061677","url":null,"abstract":"Introduction Health workers are at high risk of contracting the disease because they are at the forefront of assisting COVID19 patients. Globally, Indonesia has the worst death toll of health workers. Many previous studies have shown the differences in knowledge, attitudes, and behavior of health workers in handling with the COVID19 pandemic. This study aims to asses the role of knowledge, attitudes, and health workers' preparedness during the COVID-19 pandemic in Aceh Pidie Jaya District. Methods A cross-sectional study and the data were collected by distributing online questionnaires about knowledge, attitudes, behavior, and preparedness related to the COVID-19 at 12 Pidie Jaya District health centers. The knowledge, behavior, and preparedness parameters used Guttman and Likert scales to measure the workers' attitudes. Chi-square test was used to evaluate the relationship between knowledge, attitudes, behavior, and preparedness. Results In this study, 377 health workers were selected, the majority of respondents' education level was diploma, level 3 (257, 76.3%), and one-third of the respondents did not attend training. There are 197 (58.5%) respondents who had good knowledge, 177 (52.5%) positive attitudes, 283 (84%) good behavior, and 173 (51, 3%) well prepared. Furthermore, good knowledge, positive attitude, and good behavior had a significant correlation statistically with well prepared during the pandemic (p < 0.05). Discussion Most of the health workers in Aceh Pidie Jaya have good knowledge, positive attitudes, and good behavior that create adequate preparedness. Even though training is still very limited, educational attainment would remain the cornerstone for preparedness to encounter COVID-19.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49278256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-18DOI: 10.1177/20534345211039988
L. van Tuyl, B. Vrijhoef, M. Laurant, A. D. de Bont, R. Batenburg
Task shifting in healthcare has mainly been initiated and studied as a way to react to/or mitigate workforce shortages. Here, we define task shifting as the structural redistribution of tasks, usually including responsibilities and competencies between different professions. As such, task shifting is commonly focused on highly specialised and trained professionals who hand-over specific, standardised tasks to professionals with lower levels of education. It is expected that this type of task shifting will lead to efficiency and cost savings to healthcare organisations. Yet, there are more benefits to task shifting, in particular its contribution to integrated patient-centred quality of care and a tailored system that meets the changing care demands in society. Hence the importance to broaden the scope of task shifting, its goals, manifestations and how task shifting plays a role in addressing both the strengths and weaknesses in the healthcare system. In this focus piece, trends and conditions for task shifting and its (un)anticipated effects are discussed. We argue that, only when designed to face specific complexities at the workplace and taking into account the balance between specialists and generalists, task shifting may substantially contribute to enhanced quality of care that meets the changing needs of society.
{"title":"Broadening the scope of task shifting in the organisation of healthcare","authors":"L. van Tuyl, B. Vrijhoef, M. Laurant, A. D. de Bont, R. Batenburg","doi":"10.1177/20534345211039988","DOIUrl":"https://doi.org/10.1177/20534345211039988","url":null,"abstract":"Task shifting in healthcare has mainly been initiated and studied as a way to react to/or mitigate workforce shortages. Here, we define task shifting as the structural redistribution of tasks, usually including responsibilities and competencies between different professions. As such, task shifting is commonly focused on highly specialised and trained professionals who hand-over specific, standardised tasks to professionals with lower levels of education. It is expected that this type of task shifting will lead to efficiency and cost savings to healthcare organisations. Yet, there are more benefits to task shifting, in particular its contribution to integrated patient-centred quality of care and a tailored system that meets the changing care demands in society. Hence the importance to broaden the scope of task shifting, its goals, manifestations and how task shifting plays a role in addressing both the strengths and weaknesses in the healthcare system. In this focus piece, trends and conditions for task shifting and its (un)anticipated effects are discussed. We argue that, only when designed to face specific complexities at the workplace and taking into account the balance between specialists and generalists, task shifting may substantially contribute to enhanced quality of care that meets the changing needs of society.","PeriodicalId":43751,"journal":{"name":"International Journal of Care Coordination","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2021-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43477866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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