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Rural Appalachia has significantly higher overall cancer mortality compared with national rates, and lack of cancer screening is believed to be one of the contributing factors. Reducing the cancer disparity in this region must include strategies to address suboptimal cancer screening practices by rural Appalachian primary careproviders (PCPs). To…
Background The use of electronic health records (EHRs) to support the organization and delivery of healthcare is evolving rapidly. However, little is known regarding potential variation in access to EHRs by provider type or care setting. This paper reports on observed variation in the perceptions of access to EHRs by a wide range of cancercareproviders covering diverse cancercare settings in Ontario, Canada. Methods Perspectives were sought regarding EHR access and health record completeness for cancer patients as part of an internet survey of 5663 cancercareproviders and administrators in Ontario. Data were analyzed using a multilevel logistic regression model. Provider type, location of work, and access to computer or internet were included as covariates in the model. Results A total of 1997 of 5663 (35%) valid responses were collected. Focusing on data from cancercareproviders (N = 1247), significant variation in EHR access and health record completeness was observed between provider types, location of work, and level of computer access. Providers who worked in community hospitals were half as likely as those who worked in teaching hospitals to have access to their patients' EHRs (OR 0.45 95% CI: 0.24–0.85, p < 0.05) and were six times less likely to have access to other organizations' EHRs (OR 0.15 95% CI: 0.02–1.00, p < 0.05). Compared to surgeons, nurses (OR 3.47 95% CI: 1.80–6.68, p < 0.05), radiation therapists/physicists (OR 7.86 95% CI: 2.54–25.34, p < 0.05), and other clinicians (OR 4.92 95% CI: 2.15–11.27, p < 0.05) were more likely to report good access to their organization's EHRs. Conclusion Variability in access across different provider groups, organization types, and geographic locations illustrates the fragmented nature of EHR adoption in the cancer system. Along with focusing on technological aspects of EHR adoption within organizations, it is essential that there is cross-organizational and cross-provider access to EHRs to ensure patient continuity of care, system efficiency, and high quality care.
The incidence of colorectal cancer has been increasing in many Asian countries including Malaysia during the past few decades. A physician recommendation has been shown to be a major factor that motivates patients to undergo screening. The present study objectives were to describe the practice of colorectal cancer screening by primary careproviders in Malaysia and to determine the barriers for not following recommendations. In this cross sectional study involving 132 primary careproviders from 44 Primary Care clinics in West Malaysia, self-administered questionnaires which consisted of demographic data, qualification, background on the primary care clinic, practices on colorectal cancer screening and barriers to colorectal cancer screening were distributed. A total of 116 primary careproviders responded making a response rate of 87.9%. About 21% recommended faecal occult blood test (FOBT) in more than 50% of their patients who were eligible. The most common barrier was "unavailability of the test". The two most common patient factors are "patient in a hurry" and "poor patient awareness". This study indicates that colorectal cancer preventive activities among primary careproviders are still poor in Malaysia. This may be related to the low availability of the test in the primary care setting and poor awareness and understanding of the importance of colorectal cancer screening among patients. More awareness programmes are required for the public. In addition, primary careproviders should be kept abreast with the latest recommendations and policy makers need to improve colorectal cancer screening services in health clinics. PMID:24761922
Norwati, Daud; Harmy, Mohamed Yusoff; Norhayati, Mohd Noor; Amry, Abdul Rahim
This review provides an update on lung cancer screening with low-dose computed tomography (LDCT) and its implications for primary careproviders. One of the unique features of lung cancer screening is the potential complexity in patient management if an LDCT scan reveals a small pulmonary nodule. Additional tests, consultation with multiple specialists, and follow-up evaluations may be needed to evaluate whether lung cancer is present. Primary careproviders should know the resources available in their communities for lung cancer screening with LDCT and smoking cessation, and the key points to be addressed in informed and shared decision-making discussions with patients. PMID:24830610
Richards, Thomas B; White, Mary C; Caraballo, Ralph S
Background Little is known about the constraints of optimizing health care for prostate cancer survivors in Alaska primary care. Objective To describe the experiences and attitudes of primary careproviders within the Alaska Tribal Health System (ATHS) regarding the care of prostate cancer survivors. Design In late October 2011, we emailed a 22-item electronic survey to 268 ATHS primary careproviders regarding the frequency of Prostate Specific Antigen (PSA) monitoring for a hypothetical prostate cancer survivor; who should be responsible for the patient's life-long prostate cancer surveillance; who should support the patient's emotional and medical needs as a survivor; and providers’ level of comfort addressing recurrence monitoring, erectile dysfunction, urinary incontinence, androgen deprivation therapy, and emotional needs. We used simple logistic regression to examine the association between provider characteristics and their responses to the survivorship survey items. Results Of 221 individuals who were successfully contacted, a total of 114 responded (52% response rate). Most ATHS providers indicated they would order a PSA test every 12 months (69%) and believed that, ideally, the hypothetical patient's primary careprovider should be responsible for his life-long prostate cancer surveillance (60%). Most providers reported feeling either “moderately” or “very” comfortable addressing topics such as prostate cancer recurrence (59%), erectile dysfunction (64%), urinary incontinence (63%), and emotional needs (61%) with prostate cancer survivors. These results varied somewhat by provider characteristics including female sex, years in practice, and the number of prostate cancer survivors seen in their practice. Conclusions These data suggest that most primary careproviders in Alaska are poised to assume the care of prostate cancer survivors locally. However, we also found that large minorities of providers do not feel confident in their ability to manage common issues in prostate cancer survivorship, implying that continued access to specialists with more expert knowledge would be beneficial.
Tilburt, Jon C.; Kelley, Stacy; DeCourtney, Christine A.; Humeniuk, Katherine M.; Latini, Jerilyn; Kim, Simon P.
Today, many countries are increasing their efforts to ensure that all cancer patients receive the best possible care. Population-based cancer registries have adapted their registration to collect additional clinical variables to provide clinicians with unbiased population data on cancer treatment and survival. Taking several examples of epidemiological cancer research performed at the Geneva Cancer Registry, we aim to illustrate how cancer registries oversee the treatment and outcomes of cancer patients to help clinicians continually improve quality of care and prevent cancer deaths in the population.
BACKGROUND: Many patients with advanced cancer depend upon health careproviders for symptom assessment. The extent of agreement between patient and provider symptom assessments and the association of agreement with demographic- and disease-related factors was examined. METHODS: This cross-sectional study included 1933 patient-health careprovider dyads, from 11 European countries. Patients reported symptoms by using the four-point scales of the
Eivor A Laugsand; Mirjam AG Sprangers; Kristin Bjordal; Frank Skorpen; Stein Kaasa; Pål Klepstad
Background: Patients are more likely to be screened for colorectal cancer if it is recommended by a health careprovider. Therefore, it is imperative that providers have access to the latest screening guidelines. Purpose: This practice-based project sought to identify Kentucky primary careproviders' preferred sources and methods of receiving…
Facing a cancer diagnosis at any age is devastating. However, young cancer patients have the added burden that life-preserving cancer treatments, including surgery, chemotherapy, and radiotherapy, may compromise their future fertility. The possibility of reproductive dysfunction as a consequence of cancer treatment has a negative impact on the quality of life of cancer survivors. The field of oncofertility, which merges the clinical specialties of oncology and reproductive endocrinology, was developed to explore and expand fertility preservation options and to better manage the reproductive status of cancer patients. Fertility preservation for females has proved to be a particular challenge because mature female gametes are rare and difficult to acquire. The purpose of this article is to provide the gynecologist with a comprehensive overview of how cancer treatments affect the female reproductive axis, delineate the diverse fertility preservation options that are currently available or being developed for young women, and describe current measures of ovarian reserve that can be used pre- and post-cancer treatment. As a primary careprovider, the gynecologist will likely interact with patients throughout the cancercare continuum. Thus, the gynecologist is in a unique position to join the oncofertility team in providing young cancer patients with up-to-date fertility preservation information and referrals to specialists.
Duncan, Francesca E; Jozefik, Jennifer K; Kim, Alison M; Hirshfeld-Cytron, Jennifer; Woodruff, Teresa K
Palliative care for children and adolescents with cancer includes interventions that focus on the relief of suffering, optimization of function, and improvement of quality of life at any and all stages of disease. This care is most effectively provided by a multidisciplinary team. Nurses perform an integral role on that team by identifying symptoms, providingcare coordination, and assuring clear communication. Several basic tenets appear essential to the provision of optimal palliative care. First, palliative care should be administered concurrently with curative therapy beginning at diagnosis and assuming a more significant role at end of life. This treatment approach, recommended by many medical societies, has been associated with numerous benefits including longer survival. Second, realistic, objective goals of care must be developed. A clear understanding of the prognosis by the patient, family, and all members of the medical team is essential to the development of these goals. The pediatric oncology nurse is pivotal in developing these goals and assuring that they are adhered to across all specialties. Third, effective therapies to prevent and relieve the symptoms of suffering must be provided. This can only be accomplished with accurate and repeated assessments. The pediatric oncology nurse is vital in providing these assessments and must possess a working knowledge of the most common symptoms associated with suffering. With a basic understanding of these palliative care principles and competency in the core skills required for this care, the pediatric oncology nurse will optimize quality of life for children and adolescents with cancer.
Docherty, Sharron L.; Thaxton, Cheryl; Allison, Courtney; Barfield, Raymond C.; Tamburro, Robert F.
This paper describes a psycho-oncology consultation model of care (POCM) that provides a framework for psychosocial clinical work with cancer patients. Goals for care are addressed that follow the recommendations of the Institute of Medicine report advocating care for the "whole patient." Specific goals include reducing distress and symptoms, building on the patient's existing strengths, enhancing self-efficacy, expanding the patient's repertoire of healthy coping strategies, and addressing informational needs. Specific interventions are described that clinicians can implement in order to address the above goals. The paper also addresses the unique challenges encountered in working with cancer patients, as well as programmatic difficulties that are inherent in providing mental health care in a medical setting. PMID:20799056
Purpose To describe which providersprovide breast cancer survivorship care. Patients and Methods We conducted a longitudinal survey of non-metastatic breast cancer patients identified by the SEER registries of Los Angeles and Detroit. Multinomial logistic regression examined the adjusted odds of surgeon compared with a medical oncologist follow up or primary careprovider compared with medical oncologist follow up, adjusting for age, race/ethnicity, insurance, tumor stage, receipt of chemotherapy, endocrine therapy use, and visit to a medical oncologist at the time of diagnosis. Results were weighted to account for sample selection and non-response. Results 844 women had invasive disease and received chemotherapy or endocrine therapy. 65.2% reported medical oncologists as their main careprovider at four years, followed by PCP/other physicians (24.3%) and surgeons (10.5%). Black women were more likely to receive their follow-up care from surgeons (OR 2.47, 95% CI 1.16–5.27) or PCP/other physicians (OR 2.62, 95% CI 1.47–4.65) than medical oncologists. Latinas were more likely to report PCP/other physician follow up than medical oncologists (OR 2.33, 95% CI 1.15–4.73). Compared with privately-insured women, Medicaid recipients were more likely to report PCP/other physician follow up (OR 2.52, 95% CI 1.24–5.15). Women taking endocrine therapy four years after diagnosis were less likely to report surgeons or PCP/other physicians as their primary provider of breast cancer follow up care. Conclusions Different survivorship care patterns based on race/ethnicity and insurance status. Interventions are needed to inform patients and providers on the recommended sources of breast cancer follow up.
Friese, Christopher R.; Martinez, Kathryn A.; Abrahamse, Paul; Hamilton, Ann S.; Graff, John J.; Jagsi, Reshma; Griggs, Jennifer J.; Hawley, Sarah T.; Katz, Steven J.
Personalized medicine, the tailoring of prevention and treatment, is the future of routine clinical practice. This approach has started to appear in genetic testing for predisposition to hereditary breast and ovarian cancer (HBOC). We explored how breast-careproviders perceived HBOC risk management, using grounded theory. This study found that the frontline healthcare providers perceived HBOC risk management as still being neglected in breast cancercare. Emerging challenges included treatment priority, hesitancy to deal with sensitive issues, easily missed risks, genetic data not being shared among multidisciplinary professionals, and patients being lost to follow-up. Oncology nurses are ideally placed to facilitate communication and utilization of genetic information among multidisciplinary professionals. Specialized outpatient clinics need to be established to follow up individuals at high risk. There is a need to create a system to meet the future demands of personalized medicine in nursing practice. PMID:24580974
Context: Rural women in the United States experience disparity in breast cancer diagnosis and treatment when compared to their urban counterparts. Given the 11% chance of lifetime occurrence of breast cancer for women overall, the continuum of breast cancer screening, diagnosis, treatment, and recovery are of legitimate concern to rural women and…
For Health CareProviders Training Categories Palliative Care Clinical Trials Translational Research Palliative Care Education in Palliative and End-of-Life Care For Oncology (EPEC™-O )Format: Web-based self-study, 3 plenary sessions and 15 content
A cancer diagnosis does not prevent smoking among pediatric oncology patients, and anti-smoking communications among parents and health careproviders have been proposed as influencing smoking outcomes in this group. Anti-smoking communications were compared among 93 preadolescents with cancer and 402 controls. After adjusting for demographics and covariates, preadolescents with cancer were less likely than control participants to report receipt
Leslee Throckmorton-Belzer; Vida L. Tyc; Leslie A. Robinson; James L. Klosky; Shelly Lensing; Andrea K. Booth
Objectives: The purpose of our study was to develop and evaluate an educational program for health careproviders and patients on the topics of general breast cancer risk factors, breast cancer genetics, and breast cancer screening recommendations. The program was designed with specific emphasis on addressing the needs of medically underserved Hispanic women in Southern Texas. We also identified and
Michelle N. Strecker; Aimee J. Williams; Melissa Bondy; Dennis A. Johnston; Hope Northrup
This article describes health careproviders involved in primary care, nursing care, and specialty care. This is just ... PRIMARY CARE A primary careprovider (PCP) is a person you may see first for checkups and health ...
Purpose: Distance to provider might be an important barrier to timely diagnosis and treatment for cancer patients who qualify for Medicaid coverage. Whether driving time or driving distance is a better indicator of travel burden is also of interest. Methods: Driving distances and times from patient residence to primary careprovider were…
Scoggins, John F.; Fedorenko, Catherine R.; Donahue, Sara M. A.; Buchwald, Dedra; Blough, David K.; Ramsey, Scott D.
We evaluated knowledge of gynecologic cancer screening recommendations, screening behaviors, and communication with providers among women with Lynch syndrome (LS). Women aged ?25?years who were at risk for LS-associated cancers completed a semi-structured interview and a questionnaire. Of 74 participants (mean age 40?years), 61% knew the appropriate age to begin screening, 75-80% correctly identified the recommended screening frequency, and 84% reported no previous screening endometrial biopsy. Women initiated discussions with their providers about their LS cancer risks, but many used nonspecific terms or relied on family history. Most were not offered high-risk screening options. While many women were aware of risk-appropriate LS screening guidelines, adherence was suboptimal. Improving communication between women and their providers regarding LS-related gynecologic cancer risk and screening options may help improve adherence. PMID:23906188
Burton-Chase, A M; Hovick, S R; Sun, C C; Boyd-Rogers, S; Lynch, P M; Lu, K H; Peterson, S K
Background Palliative cancercare aims to improve quality of life and ultimately quality of dying, while prolonging life is not an objective anymore when death nears. The question is, however, whether these perspectives on palliative care are congruent with the perspectives of immigrant families with a Turkish or Moroccan background. Methods A qualitative design was used as we were looking for the personal views of 'very ill' cancer patients with a Turkish or Moroccan background, their family members and their Dutch careproviders. We interviewed 83 people, involved in 33 cases to obtain information about their views, values and norms on 'good care'. Results The main concerns about 'good care' expressed by Turkish and Moroccan families were: maximum treatment and curative care until the end of their lives, never having hope taken away, devoted care by their families, avoiding shameful situations, dying with a clear mind and being buried in their own country. Their views conflict, to some extent, with the dominant principles in palliative care, for example, the emphasis on quality of life and advanced care planning, which includes discussing diagnosis and prognosis with the patient. Conclusions Patients and their families with a Turkish or Moroccan background often have different ideas about 'good care' than their Dutch careproviders. As many of them are aiming at cure until the end of life, they find 'good palliative care' a contradiction in terms.
Background There is a need for improvement of information provision and post-treatment care for cancer survivors. A Survivorship Care Plan (SCP) is recommended by the American Institute of Medicine and the Dutch Health Council, which is a summary of patients' course of treatment as a formal document, and includes recommendations for subsequent cancer surveillance, management of late effects, and strategies for health promotion. Until now, evidence on the effects of implementing the SCP in clinical practice is lacking. The rationale and study design of a pragmatic cluster randomized trial, aiming to assess the impact of SCP care in routine clinical practice, is presented. Methods/Design A web-based patient registration system 'Registrationsystem Oncological GYnecology' (ROGY) is used by gynecologists in the South of the Netherlands since 2006. A personalized SCP can automatically be generated out of ROGY. In this pragmatic cluster randomized controlled trial, 12 hospitals are randomized to either 'usual care' or 'SCP care'. In patients with 'usual care', the gynecologist providescare as usual. In patients with 'SCP care', information about the tumor stage and treatment is personally discussed with the patient and a document is handed to the patient. Prospectively, all patients diagnosed with endometrial or ovarian cancer in the participating hospitals will be approached for study participation. Patients will complete questionnaires after surgery, and before additional treatment, and after 6, 12, 18 and 24 months. In addition, health careproviders will be asked their opinion about implementation of SCP care. Primary outcome is defined as patient satisfaction with information provision and care. Secondary outcomes are illness perception, health-related quality of life, health care use, prevalence, course and referral rate of survivors with psychosocial distress, and health careproviders' evaluation of SCP care. Discussion The ROGY Care trial will help to gain insight into the impact of SCP care on patient reported outcomes, and on the evaluation of cancer survivors and health careproviders of the different elements of the SCP. Therefore, results will contribute to efforts to improve quality of care for cancer survivors. Trial registration Trial Registration: http://www.ClinicalTrials.gov. Identifier: NCT01185626 Medical Research Ethics Committee Reference Number: NL33429.008.10 Grant Reference Number: UVT2010-4743
Family doctor - how to choose one; Primary careprovider - how to choose one; Doctor - how to choose a family doctor ... care Make referrals to medical specialists when necessary Primary care is usually provided in an outpatient setting. However, ...
Objectives To find out factors that are responsible for the patient or provider delays in the diagnosis of breast cancer in India. Design This prospective study was designed to be conducted over a period of two years including a cohort of 100 patients with locally advanced breast cancer. The delays were assessed using questionnaires prepared according to the Indian scenario. Setting A prospective study in an Indian setting. Participants One hundred patients with locally advanced breast cancer receiving neoadjuvant chemotherapy were included after providing informed consent and receiving ethical committee clearance. Main outcome measures The most common factor responsible for delays in diagnosis was observed to be the health providers, although illiteracy and lack of adequate healthcare services also contributed significantly. Unregistered medical practitioners or quacks contributed significantly to the delays in reporting and diagnosis of the disease. Results One hundred patients of locally advanced breast cancer were evaluated using standardized questionnaires to assess the delays in diagnosis. Provider delays were found to be significant (the unregistered doctors or quacks being a significant cause of delays).The average time lapse before diagnosis for rural patients was higher (67.5 days) compared to urban patients (53.7 days). The literacy levels of the patients also had a significant impact on the delays at diagnosis. The delay in illiterates was 60.6 days compared to 49.5 days for literates. Conclusions The most common factor responsible for delays in reporting and diagnosis was observed to be at the end of the health providers, although illiteracy and lack of adequate healthcare services also contributed significantly. Unregistered medical practitioners or quacks contributed significantly to the delays in reporting and diagnosis of the disease.
Background Survivorship care plans have been recommended by the Institute of Medicine for all cancer survivors. We implemented an Internet-based tool for creation of individualized survivorship care plans. To our knowledge, this is the first tool of this type to be designed and made publicly accessible. Objective To investigate patterns of use and satisfaction with an Internet-based tool for creation of survivorship care plans. Methods OncoLife, an Internet-based program for creation of survivorship care plans, was designed by a team of dedicated oncology nurses and physicians at the University of Pennsylvania. The program was designed to provide individualized, comprehensive health care recommendations to users responding to queries regarding demographics, diagnosis, and cancer treatments. After being piloted to test populations, OncoLife was made publicly accessible via Oncolink, a cancer information website based at the University of Pennsylvania which averages 3.9 million page views and over 385,000 unique visits per month. Data entered by anonymous public users was maintained and analyzed. Results From May 2007 to November 2008, 3343 individuals utilized this tool. Most (63%) identified themselves as survivors, but also health careproviders (25%) and friends/family of survivors (12%). Median age at diagnosis was 48 years (18 - 100+), and median current age 51 (19 - 100+). Most users were Caucasian (87%), female (71%), and college-educated (82%). Breast cancer was the most common diagnosis (46%), followed by hematologic (12%), gastrointestinal (11%), gynecologic (9%), and genitourinary (8%). Of all users, 84% had undergone surgery, 80% chemotherapy, and 60% radiotherapy. Half of users (53%) reported receiving follow-up care from only an oncologist, 13% only a primary careprovider (PCP), and 32% both; 12% reported having received survivorship information previously. Over 90% of users, both survivors and health careproviders, reported satisfaction levels of “good” to “excellent” using this tool. Conclusions Based on our experience with implementation of what is, to our knowledge, the first Web-based program for creation of survivorship care plans, survivors and health careproviders appear both willing to use this type of tool and satisfied with the information provided. Most users have never before received survivorship information. Future iterations will focus on expanding accessibility and improving understanding of the needs of cancer survivors in the era of the Internet.
Vachani, Carolyn; Hampshire, Margaret K; Jacobs, Linda A; Metz, James M
Family day careproviders are responsible for creating a high-quality program where children have opportunities to grow, learn and thrive. Part of providing high-quality child care includes complying with the family day care regulations from the New York State Office of Children and Family Services (OCFS). This Handbook will help day care…
New York State Office of Children and Family Services, 2006
From 1985 to 1988, a state-wide program of cancer education was offered to community-based allied health professionals (AHPs) at five different program sites in Pennsylvania. During this three-year period, 512 social workers, clergy, dieticians, physical therapists and others received training to increase their knowledge about cancer and counseling, improve their supportive attitude regarding cancer patients and families, and decrease stress related to their work with this population. Overall, the Program was successful in reaching AHPs working with cancer clients who had little formal training in the cancer field. At the beginning of training, it was observed that AHPs with initially higher levels of education and more years of work experience with cancer patients had higher levels of counseling knowledge. Those who were women, worked in hospitals, or had worked with cancer patients longer exhibited higher levels of cancer knowledge. Participants who were women and who had more education had reported lower levels of job stress. Among those AHPs who completed the training courses, cancer knowledge increased by 14 percent. In addition, knowledge related to counseling cancer patients and their families improved by 11 percentage points. Perceived job stress among the AHPs also declined by 10 percent. Finally, participant supportive attitude concerning cancer clients improved. PMID:10116581
Colorectal cancer screening (CRCS) rates are low among men and women who seek health care at federally qualified health centers (FQHCs). This study explores health careproviders' perspectives about their patient's motivators and impediments to CRCS and receptivity to preparatory education. A mixed methods design consisting of in-depth interviews, focus groups, and a short survey is used in this study. The participants of this study are 17 health careproviders practicing in FQHCs in the Tampa Bay area. Test-specific patient impediments and motivations were identified including fear of abnormal findings, importance of offering less invasive fecal occult blood tests, and need for patient-centered test-specific educational materials in clinics. Opportunities to improve provider practices were identified including providers' reliance on patients' report of symptoms as a cue to recommend CRCS and overemphasis of clinic-based guaiac stool tests. This study adds to the literature on CRCS test-specific motivators and impediments. Providers offered unique approaches for motivating patients to follow through with recommended CRCS and were receptive to in-clinic patient education. Findings readily inform the design of educational materials and interventions to increase CRCS in FQHCs. PMID:23943277
Gwede, Clement K; Davis, Stacy N; Quinn, Gwendolyn P; Koskan, Alexis M; Ealey, Jamila; Abdulla, Rania; Vadaparampil, Susan T; Elliott, Gloria; Lopez, Diana; Shibata, David; Roetzheim, Richard G; Meade, Cathy D
Many cancer survivors suffer from chronic pain related to treatment. Pain management in the survivor is similar to chronic noncancer pain, with the important caveat that new or worsening pain must be promptly assessed for malignancy. This article reviews cancer survivorship, identifies common pain problems, and discusses strategies for management. PMID:23640011
The purpose of the study was to obtain an in-depth understanding of the perceptions of advanced practice providers (APPs) with respect to their current roles in the context of the transition to a new cancercare delivery system, as well as factors that may influence their ability to practice at their level of training and education. Five focus groups were conducted with 15 APPs (11 nurse practitioners, 4 physician assistants). Data were collected by a recorder at each focus group. Four investigators reviewed the data from each group for accuracy and to generate an initial set of codes. Codes were compared across reviewers until consensus was reached and final themes were agreed upon. The mean age of the participants was 43.5 years (range: 27 to 63 years). The APPs practiced for an average of 11 years (range: 1 to 27 years), with a mean of 6.5 years in oncology (range: 1 to 11 years). Six themes were generated from the data related to the APP role during the transition to a new oncology care system: experiencing role tension, facing communication barriers, seeking mentorship, dealing with fragmented care, recognizing the need for professional growth, and navigating a new system. Our findings may inform administrators about the role of the APP in quality care delivery. These findings may empower APPs to practice to the full scope of their training and educational preparation, thereby facilitating their goals for professional development.
... treatment plan. “Careprovider” means a doctor, a physician’s assistant, or a nurse practitioner. There are several issues you may want to consider in choosing an HIV careprovider. You might decide to ... from physicians who are specialists in infectious diseases. However, especially ...
The aim of this study was to understand children's cancer nurses experiences of providing palliative care in the acute hospital setting. Palliative care for children with cancer is rarely hospital- centred and predominately care is provided in the community or hospice setting. Vast research has looked at the experiences of children's nurses providing palliative care within the child's home environment or the hospice. This research has suggested that nurses need adequate support to avoid stress and burnout. Parental views focus on the nurses attributes as opposed to the clinical skills which are required. This research study wanted to ascertain whether specific educational preparation or support is needed to prepare children's cancer nurses in providing palliative care in the acute hospital setting. The research study used a qualitative approach with semi-structured in-depth interviews across three primary treatment centers within the United Kingdom that providecancercare to children. Data were collected and analyzed using a phenomenological approach. Data were collected between October 2011 and February 2012. Interviews took place in the participants preferred location and lasted between 45 and 60 min. Data were analyzed using the Strauss and Corbin method. Five themes emerged which were "lack of a plan", "managing the symptoms", 'family", and "experience". Categories within these themes were devised from participant narratives. The findings of this research study suggest nurses need specific palliative care education not only at pre-registration level but also continuing professional development. PMID:23758218
Work is underway to make cancer a working model for quality of care research and the translation of this research into practice. This requires addressing how data collection about cancercare can be standardized and made most useful to a variety of audiences including providers, patients and their families, purchasers, payers, researchers, and policymakers. The Applied Research Program has spearheaded several key activities to carry out this initiative.
Reflecting a trend toward reconsideration of medical care which concentrates only on the treatment of disease, a new paradigm of "palliative care" has recently been developed with a focus on the treatment of cancer patients. As part of our palliative care program, we have provided an "outpatient salon" for outpatients in the Department of Radiology of this hospital. The goal of the outpatient salon is to assist patients who live at home in coping with their disease. We regard this outpatient salon as a preparatory step in establishing a palliative day care center to support patients and their families at home and to improve patient QOL. Currently, two staff members are acting as counselors at the salon, and most of the patients visiting the salon are breast cancer patients. The salon appears to provide the following benefits to patients: 1) self-assurance, by allowing them to talk to others about their problems, 2) development of self-help skills, through involvement with other patients, 3) a place to relax, and 4) comfort from focusing. We have two future goals: to develop the salon into a day care center, and to nurture a self-help group within the salon. PMID:9445159
Group family day careproviders need to create high-quality programs where children have opportunities to grow, learn and thrive. Part of providing high-quality child care includes complying with the group family day care regulations from the New York State Office of Children and Family Services (OCFS). This Handbook will help day careproviders:…
New York State Office of Children and Family Services, 2006
At least 1 in 5 Americans die while using intensive care service-a number that is expected to increase as society ages. Many of these deaths involve withholding or withdrawing life-sustaining therapies. In these situations, the role of intensive care nurses shifts from providing aggressive care to end-of-life care. While hospice and palliative care nurses typically receive specialized support to cope with death and dying, intensive care nurses usually do not receive this support. Understanding the experiences of intensive care nurses in providingcare at the end of life is an important first step to improving terminal care in the intensive care unit (ICU). This phenomenological research study explores the experiences of intensive care nurses who provide terminal care in the ICU. The sample consisted of 18 registered nurses delivering terminal care in an ICU that participated in individual interviews and focus groups. Colaizzi's steps for data analysis were used to identify themes within the context of nursing. Three major themes consisted of (1) barriers to optimal care, (2) internal conflict, and (3) coping. Providing terminal care creates significant personal and professional struggles among ICU nurses. PMID:20551742
Patients with cancer in the UK suffer more delays and worse survival than those in many other European states. The national cancer plan has set ambitious targets for improved care. The cancer services collaborative is using improvement methods to reduce delays and improve the service for patients. The nine cancer networks using these methods have cut waiting times and improved patients' experiences of care. PMID:11799037
Kerr, David; Bevan, Helen; Gowland, Ben; Penny, Jean; Berwick, Don
Health careproviders exert a significant influence on parental pediatric vaccination decisions. We conducted hour-long interviews with traditional and alternative health careproviders in which we explored a range of associations between vaccination perceptions and practice. A key finding was that the Health Belief Model constructs of perceived susceptibility to and severity of either an illness or an adverse vaccine event partially explained health careprovider (HCP) beliefs about the risks or benefits of vaccination, especially among alternative careproviders. Low or high perceived susceptibility to a vaccine-preventable disease (VPD) or of the severity of a given VPD affects whether an HCP will promote or oppose pediatric vaccination recommendations. Beyond these perceptions, health and vaccination beliefs are affected by the contextual factors of personal experience, group norms, immunology beliefs, and beliefs about industry and government. Building powerful affective heuristics might be critical to balancing the forces that defeat good public health practices. PMID:23964059
... address specific palliative care issues, such as lymphedema , pain management, sexual functioning, or psychosocial issues. A patient may ... of Cancer Survivorship sponsors research that addresses symptom management for patients ... neuropathy , pain, and sleep problems. Trials that are designed to ...
Smoking in CancerCare (PDQ®) Patient Version Health Professional Version En español Last Modified: 06/27/2014 Smoking in ... cancer patients, including second cancers. Counseling to help cancer patients quit smoking. Treatment with drugs to help cancer patients quit ...
A fact sheet that describes the role of palliative care, which is comfort care given to a patient who has a serious or life-threatening disease, such as cancer, from the time of diagnosis and throughout the course of illness.
Culturally sensitive information is crucial for providing appropriate care to any minority population. This article provides an overview of important issues to consider when working with transgender patients, including clarification of transgender terminology, diagnosis issues, identity development, and appropriate pronoun use. We also review…
Maguen, Shira; Shipherd, Jillian C.; Harris, Holly N.
This qualitative study examined perceptions of foster-careproviders, service providers, and juvenile-court judges regarding privatized foster-care services in Kansas. Kansas was the first state to privatize all foster care, adoption, and family-preservation services. Most states report either beginning to implement managed-care principles in their child welfare services or exploring this option. Fifty-eight interviews with 33 participants (youth in out-of-home placements,
Kristen R. Humphrey; Ann P. Turnbull; H. Rutherford Turnbull III
Context: Pesticide exposure is an important environmental and occupational health risk for agricultural workers and their families, but health careproviders receive little training in it. Objective: To evaluate the medical resources available to providerscaring for patients, particularly farmworkers, exposed to pesticides and to recommend a…
Hiott, Ann E.; Quandt, Sara A.; Early, Julie; Jackson, David S.; Arcury, Thomas A.
A resource for child caregivers providing family day care for infants and toddlers, this book is designed to provide information and suggestions in a format that is easy to follow, and in language that is easy to read. Chapter 1 gives tips on "baby-proofing" the home, as well as ideas for toys, equipment, and how to integrate a baby into the…
To deal with the suffering caused by childhood cancer, patients and their families use different coping strategies, among which, spirituality appears a way of minimizing possible damage. In this context, the purpose of the present study was to analyze the influence of spirituality in childhood cancercare, involving biopsychosocial aspects of the child, the family, and the health care team facing the disease. To accomplish this purpose, a nonsystematic review of literature of articles on national and international electronic databases (Scientific Electronic Library Online [SciELO], PubMed, and Latin American and Caribbean Health Sciences Literature [LILACS]) was conducted using the search terms “spirituality,” “child psychology,” “child,” and “cancer,” as well as on other available resources. After the search, 20 articles met the eligibility criteria and were included in the final sample. Our review showed that the relation between spirituality and health has lately become a subject of growing interest among researchers, as a positive influence of spirituality in the people’s welfare was noted. Studies that were retrieved using the mentioned search strategy in electronic databases, independently assessed by the authors according to the systematic review, showed that spirituality emerges as a driving force that helps pediatric patients and their families in coping with cancer. Health care workers have been increasingly attentive to this dimension of care. However, it is necessary to improve their knowledge regarding the subject. The search highlighted that spirituality is considered a source of comfort and hope, contributing to a better acceptance of his/her chronic condition by the child with cancer, as well as by the family. Further up-to-date studies facing the subject are, thus, needed. It is also necessary to better train health care practitioners, so as to provide humanized care to the child with cancer.
Lima, Nadia Nara Rolim; do Nascimento, Vania Barbosa; de Carvalho, Sionara Melo Figueiredo; Neto, Modesto Leite Rolim; Moreira, Marcial Moreno; Brasil, Aline Quental; Junior, Francisco Telesforo Celestino; de Oliveira, Gislene Farias; Reis, Alberto Olavo Advincula
Abstract Objective To gain a deeper understanding of how primary care (PC) practices belonging to different models manage resources to provide high-quality care. Design Multiple-case study embedded in a cross-sectional study of a random sample of 37 practices. Setting Three regions of Quebec. Participants Health care professionals and staff of 5 PC practices. Methods Five cases showing above-average results on quality-of-care indicators were purposefully selected to contrast on region, practice size, and PC model. Data were collected using an organizational questionnaire; the Team Climate Inventory, which was completed by health care professionals and staff; and 33 individual interviews. Detailed case histories were written and thematic analysis was performed. Main findings The core common feature of these practices was their ongoing effort to make trade-offs to deliver services that met their vision of high-quality care. These compromises involved the same 3 areas, but to varying degrees depending on clinic characteristics: developing a shared vision of high-quality care; aligning resource use with that vision; and balancing professional aspirations and population needs. The leadership of the physician lead was crucial. The external environment was perceived as a source of pressure and dilemmas rather than as a source of support in these matters. Conclusion Irrespective of their models, PC practices’ pursuit of high-quality care is based on a vision in which accessibility is a key component, balanced by appropriate management of available resources and of external environment expectations. Current PC reforms often create tensions rather than support PC practices in their pursuit of high-quality care.
Implementing personalized cancercare requires a sound understanding of cancer genomics, familiarity with the analytical methods used to study cancer, knowledge of the mechanisms of action of targeted drugs, and ways to assimilate and understand complex data sets. Perhaps the greatest challenge is obtaining the drugs predicted to be beneficial based on the genomic profile of a patient's tumour. A potential solution is creation of a national facilitated access programme and registry for off-label use of targeted anti-cancer drugs. Within such a programme, patients could receive the targeted agent matched to the genomic profile of their tumour. Physicians would receive guidance in interpretation of complex genomic tests and access to drugs. Pharmaceutical companies, payers and regulators would receive data on off-label drug and test use and clinical outcomes to inform their research and development plans and coverage decisions and to track real-world safety. Although recently launched prospective clinical trials will determine the true benefit of matching drugs to genomic alterations, the approach proposed here will facilitate delivery of personalized medicine services to participating patients while at the same time making observations that allow us to learn from each patient to inform clinical care and future research initiatives. PMID:24687035
...Implementation specifications: Health careproviders. 162.410 Section...Standard Unique Health Identifier for Health CareProviders Â§ 162.410 Implementation specifications: Health careproviders. (a) A covered...
...Implementation specifications: Health careproviders. 162.410 Section...Standard Unique Health Identifier for Health CareProviders Â§ 162.410 Implementation specifications: Health careproviders. (a) A covered...
...Implementation specifications: Health careproviders. 162.410 Section...Standard Unique Health Identifier for Health CareProviders Â§ 162.410 Implementation specifications: Health careproviders. (a) A covered...
... works best for you. To learn more about kidney disease, treatment options, and dialysis care, talk with your care ... groups, or other ways to learn more about kidney disease and its treatment? Knowing more about kidney disease and its treatments ...
The Patient Protection and Affordable Care Act (ACA) was signed into law by President Barack Obama in 2010. While initial implementation of the law began shortly thereafter, the full implementation will take place over the next few years. With respect to cancercare, the act was intended to make care more accessible, affordable, and comprehensive across different parts of the country. For our cancer patients and our practices, the ACA has implications that are both positive and negative. The Medicaid expansion and access to insurance exchanges are intended to increase the number of insured patients and thus improve access to care, but many states have decided to opt out of the Medicaid program and in these states access problems will persist. Screening programs will be put in place for insured patients but may supplant federally funded programs that are currently in place for uninsured patients and may not follow current screening guidelines. Both hospice and home health providers will be asked to provide more services with less funding, and quality measures, including readmission rates, will factor into reimbursement. Insured patients will have access to all phases of clinical trial research. There is a need for us as providers of Gynecologic Oncology care to be active in the implementation of the ACA in order to ensure that our patients and our practices can survive and benefit from the changes in health care reimbursement, with the ultimate goals of improving access to care and quality while reducing unsustainable costs. PMID:23500090
In an era of growing knowledge about genetics and health, primary-care physicians will have increasing responsibility for evaluating genetic risk and using genetic tests. Although most have little knowledge of genetics, their expertise in the prudent use of technology is relevant to the task. Successful educational programmes will need to forge partnerships between primary care and genetics.
Step 3 of the Ten Steps of Mother-Friendly Care insures that women receive care that is sensitive and responsive to the specific beliefs, values, and customs of the mother's ethnicity and religion. The rationale for this step and the evidence in support of its value are presented.
Individuals with schizophrenia are a vulnerable population that has been relatively neglected in health disparities research. Despite having an equivalent risk of developing most cancers, patients with schizophrenia are more likely to die of cancer than the general population. Cancercare disparities are likely the result of patient-, provider-, and systems-level factors and influenced by the pervasive stigma of mental illness. Individuals with schizophrenia have higher rates of health behaviors linked with cancer mortality including cigarette smoking. They also have significant medical comorbidity, are less likely to have up-to-date cancer screening, and may present at more advanced stages of illness. Patients with schizophrenia may be less likely to receive chemotherapy or radiotherapy, have more postoperative complications, and have less access to palliative care. However, opportunities exist for the interdisciplinary team, including medical, surgical, and radiation oncologists; psychiatrists; and primary care physicians, to intervene throughout the continuum of cancercare to promote survival and quality of life. This review summarizes data on overall and cancer-specific mortality for individuals with schizophrenia and reviews specific disparities across the cancercare continuum of screening, diagnosis, treatment, and end-of-life care. Using a case, the authors illustrate clinical challenges for this population including communication, informed consent, and risk of suicide, and provide suggestions for care. Finally, recommendations for research to address the disparities in cancercare for individuals with schizophrenia are discussed. Despite significant challenges, with collaboration between oncology and mental health teams, individuals with schizophrenia can receive high-quality cancercare. PMID:24151022
Irwin, Kelly E; Henderson, David C; Knight, Helen P; Pirl, William F
Many cancer centers today focus on providing comprehensive, multidisciplinary care that involves family and friends in the treatments and support services for cancer patients. Wagner's Chronic Care Model is one such model that can be used to provide this ...
This article focuses on the provision and financing of aged care in Australia. Demand for aged care will increase substantially as a result of population aging, with the number of Australians aged 85 and over projected to increase from 400,000 in 2010 to over 1.8 million in 2051. Meeting this demand will greatly strain the current system, and makes it important to exploit opportunities for increased efficiency. A move to greater beneficiary co-payments is also likely, though its extent may depend on whether aged care insurance and other forms of pre-payment can develop.
The number of cancer survivors has been steadily increasing due in part to the aging population and advancements in cancercare and treatment. Of the current 13.7 million cancer survivors in the United States, most are 65 or older. Aging changes and the presence of comorbidities add complexity to the care of cancer survivors. In addition. common long-term cancer-related symptoms and late effects of cancer treatments provide challenges to nurses and other health professionals caring for older cancer survivors. Transition from oncology care to primary or shared care requires understanding of detailed information about the specific cancer diagnosis, treatments received, and recommendations for follow-up care to prevent recurrence, recognize treatment-associated health effects, and understand strategies for health promotion. Nurses in all practice areas will care for cancer survivors and must be prepared to deliver safe and effective care. PMID:23980661
This paper describes an educational project intended to evaluate pharmacy students' abilities to provide direct patient care utilizing the pharmaceutical care process. Fourteen students enrolled in an elective course and providedcare for 18 patients throughout spring quarter 1998. There were a total of 61 drug therapy problems identified in this patient population. The Assurance Patient-Centered Pharmaceutical Care Program (version
Cancer has a significant impact on the Australian community. One in three men and one in four women will develop cancer by the age of 75. The estimated annual health expenditure due to cancer in 2000-1 in Australia was $2.7 billion, representing 5.5% of the country’s total healthcare expenditure. An historical overview of the national cancer control strategies in Australia is provided. In males, the five most common cancers in order of decreasing incidence are: prostate cancer, colorectal cancer, lung cancer, melanoma and lymphoma, while for Australian women, breast cancer is the most common cancer. Key epidemiologic information about these common cancers, current management issues and comprehensive national clinical practice guidelines (where available) are highlighted. Aspects of skin cancer, a particularly common cancer in the Australian environment – with a focus on melanoma – are also included. Cancer outcomes in Australia, measured by selected outcomes, are among the best in the world. However, there is still evidence of health inequalities, especially among patients residing in regional and remote areas, the indigenous population and people from lower socio-economic classes. Limitations of current cancercare practices in Australia, including provision of oncology services, resources and other access issues, as well as suggested improvements for future cancercare, are summarised. Ongoing implementation of national and state cancer control plans and evaluation of their effectiveness will be needed to pursue the goal of optimal cancercare in Australia.
The population of cancer survivors in the United States and worldwide is rapidly increasing. Many survivors will develop health conditions as a direct or indirect consequence of their cancer therapy. Thus, models to deliver high-quality care for cancer survivors are evolving. We provide examples of three different models of survivorship care from a cancer center, a community setting, and a country-wide health care system, followed by a description of the ASCO Cancer Survivorship Compendium, a tool to help providers understand the various models of survivorship care available and integrate survivorship care into their practices in a way that fits their unique needs. PMID:24857078
Oeffinger, Kevin C; Argenbright, Keith E; Levitt, Gill A; McCabe, Mary S; Anderson, Paula R; Berry, Emily; Maher, Jane; Merrill, Janette; Wollins, Dana S
... 40 years, community health centers (CHCs) have provided primary care and behavioral and mental health services in medically ... 72%) and PAs (72%) served as the patient's primary careprovider more frequently than NPs (58%). Table 1. ...
Context: Rural patients have limited access to dermatologic care. Farmworkers have high rates of skin disease and limited access to care. Purpose: This exploratory study assessed whether teledermatology consultations could help meet the needs of health careproviders for farmworkers in rural clinics. Methods: Dermatologists provided 79…
Vallejos, Quirina M.; Quandt, Sara A.; Feldman, Steven R.; Fleischer, Alan B., Jr.; Brooks, Thanh; Cabral, Gonzalo; Heck, Judy; Schulz, Mark R.; Verma, Amit; Whalley, Lara E.; Arcury, Thomas A.
Child careproviders are likely to be the professionals who most frequently interact with families with young children. Thus, infant and toddler child careproviders are uniquely positioned to recognize and respond to families' needs for information and support. This article describes knowledge, skills, and strategies that support child care…
Seibel, Nancy L.; Gillespie, Linda G.; Temple, Tabitha
Family physicians traditionally have played an integral role in delivering babies as a component of the comprehensive care they provide for women. The proportion of family physicians who report providing any maternity care continues to decrease. This trend is particularly concerning because family physicians are the most widely distributed specialty and are essential to health care access in rural areas. PMID:22570387
Tong, Sebastian T C; Makaroff, Laura A; Xierali, Imam M; Parhat, Parwen; Puffer, James C; Newton, Warren P; Bazemore, Andrew W
The aim of any health care service is to provide optimal quality care to clients and families regardless of their ethnic group. As today's Australian society comprises a multicultural population that encompasses clients with different cultural norms and values, this study examined undergraduate nursing students' self-efficacy in providing transcultural nursing care. A sample of 196 nursing students enrolled in the
Palliative care seems the right approach to dementia, except that it suggests a dichotomy between cure and care. As in cancer\\u000a care, supportive careprovides a broader framework, viewing dementia from the time of diagnosis until death and bereavement.\\u000a The challenge is to find the right approach to the individual. This challenge arises in the person’s own home, in long-term
Health professionals are vulnerable to occupational stress and tend to report high levels of secondary trauma and burnout; this is especially so for those working in "high-death" contexts such as cancer support and palliative care. In this study, 38 health professionals (psychologists, social workers, pastoral carers/chaplains, nurses, group facilitators, and a medical practitioner) who provide grief support and counseling in cancer and palliative care each participated in a semistructured interview. Qualitatively, a grounded theory analysis revealed four themes: (a) the role of health professionals in supporting people who are experiencing grief and loss issues in the context of cancer, (b) ways of working with patients with cancer and their families, (c) the unique qualities of cancer-related loss and grief experiences, and (d) the emotional demands of the work and associated self-care. The provision of psychological services in the context of cancer is colored by the specter of cancer, an unseen yet real phenomenon that contributes to secondary trauma and burnout. The participants' reported secondary trauma has serious repercussions for their well-being and may compromise the care they provide. The findings have implications for the retention and well-being of personnel who provide psychosocial care in cancer and the quality and delivery of services for people with cancer and their families. PMID:24079353
Breen, Lauren J; O'Connor, Moira; Hewitt, Lauren Y; Lobb, Elizabeth A
Providing Everyday Care for People with AD Activity and exercise Being active and getting exercise helps people with AD feel better. ... to make sure the person eats well" . Everyday care At some point, people with AD will need ...
Objective To assess cancer patients’ utilization of complementary and alternative medical providers and the associated expenditures by specific treatment phases. Study Design Cross-sectional analysis of medical services utilization and expenditures during three therapeutic intervals: an initial treatment phase, continuing care, and end-of-life. Methods Analysis of an insurance claims database that had been matched to the Washington State SEER cancer registry. Results Of 2,900 registry-matched cancer patients 63.2% were female, the median age was 54 years, and 92.7% were white. Breast cancer was the most frequent diagnosis (52.7%), followed by prostate cancer (24.7%), lung cancer (10.1%), colon cancer (7.0%), and hematologic malignancies (5.6%). CAM provider using patients were 26.5% of the overall cohort (18.5% used chiropractors, 7.7% naturopathic physicians, 5.3% massage therapists, and 4.2% saw acupuncturists). The proportion of CAM using patients was similar during each treatment phase. All patients used some conventional care. Female gender, a breast cancer diagnosis, age, and white race were significant predictors of CAM use. Diagnosis of a musculoskeletal problem occurred at sometime during the study for 72.1% of cancer patients. CAM provider visits were 7.2% of total outpatient medical visits and 85.1% of CAM visits resulted in a musculoskeletal diagnosis. Expenditures for CAM providers were 0.3%, 1.0%, and 0.1% of all expenditures during the initial, continuing, and end-of-life phases respectively. Conclusion For cancer patients, musculoskeletal issues were the most commonly listed diagnosis made by a CAM provider. Although expenditures associated with CAM are a small proportion of the total, additional studies are necessary to determine the importance patients place on access to these services.
Lafferty, William E.; Tyree, Patrick T.; Devlin, Sean M.; Andersen, M. Robyn; Diehr, Paula K.
This study investigated the oral hygiene care (OHC) activities and attitudes of careproviders in Intermediate Care Facilities for the Mentally Retarded (ICF/MR) in the state of Iowa. Questionnaires were distributed to careproviders employed at three ICF/MRs. About 98% of the staff ranked OHC as important to extremely important for residents. Twenty-three percent disliked OHC occasionally or more frequently. Lack of time and lack of staff were the main reasons preventing careproviders from assisting residents with OHC. Residents' behaviors resulted in inadequate OHC for 64.9%, and 49% of residents required complete assistance with OHC. Most common OHC difficulties reported were residents biting the toothbrush, refusing OHC, or not opening their mouths. Subjects reported spending 3.0 minutes brushing a resident's teeth and 3.0 minutes cleaning dentures. Careproviders experienced significant behavioral and physical difficulties while providing OHC, but still found OHC important. Training programs for careproviders are needed to address these difficulties. PMID:20500704
Thole, Karla; Chalmers, Jane; Ettinger, Ronald L; Warren, John
Skip to Main Content at the National Institutes of Health | www.cancer.gov Epidemiology and Genomics Research In NCI's Division of Cancer Control and Population Sciences Menu Search EGRP Site: EGRP Home About the Program Mission & Vision Organizational
: Skin cancer screening (SCS) promotes early detection and improves treatment. Primary careproviders are strategically positioned to provide screenings, yet the frequency is low. Strategies to improve SCS include increasing skin cancer awareness, targeting high-risk patient populations, and advocating for primary careproviders to conduct screenings. PMID:24739432
As more mothers of young children work, concerns about child care have gained prominence. Analyses of this topic typically address availability, safety, and costs of care, or the impact of care on children's "outcomes." When providers' input is included, it is generally used as an assessment tool to reinforce the researcher's conceptual framework.…
Over the last few decades the attention devoted to the palliative aspects of medicine, particularly those in hospital care, has declined due to the emphasis on medical technology. In Anglo-Saxon countries a review of this development resulted in structured palliative care that benefited terminally ill patients with a progressive fatal disease, especially cancer patients. Due to increasing national and international criticism of both the practice of euthanasia (assumed to be too liberal) and the lack of attention devoted to structured palliative care in the Netherlands, the Dutch government decided to improve the structure of palliative care. The government's viewpoint is based on the assumption that good palliative care that includes adequate pain control benefits patient care and might eventually lead to fewer requests for euthanasia. The improvements to palliative care should be realised by means of improvements in the structure, training and knowledge. Six academic medical clusters have been designated as Centres for the Development of Palliative Care (Dutch acronym: COPZ) for a 5-year period. Each COPZ must develop the various aspects needed to improve palliative care within the region it serves and ensure that its activities are carefully coordinated with those in the other centres. Research will focus on measuring the efficacy of palliative care as well as ethical and epidemiological aspects. A government committee will assess the appropriateness of the activities undertaken by each of the centres. PMID:11695096
Survivorship care plans have received increasing attention since the 2006 release of the Institute of Medicine report, From Cancer Patient to Cancer Survivor: Lost in Transition. The report strongly recommends that at completion of cancer treatment, clinicians provide patients with a summary of treatment delivered and a detailed plan of ongoing care, including follow-up schedules for visits and testing, as well as recommendations for early detection and management of treatment-related effects and other health problems. Templates have been developed by various groups to support the effort involved in complying with this recommendation. Barriers exist, such as difficulties in accessing information, preparation time involved for busy clinicians, lack of third-party reimbursement, and absence of clear guidelines for follow-up care after cancer treatment. The absence of research related to care plans and patient outcomes also calls their necessity into question. Yet, there is a growing acceptance among oncology physicians and nurses that having a plan of care is an essential component of quality survivorship care. PMID:19860042
In an effort to explain the high turnover rate among family day care (FDC) providers, a study of the effects of perceived social support, job satisfaction, and the establishment of boundaries between a family day careprovider's nuclear family and her FDC system was conducted. Analysis of data gathered from a mail survey of over 300 currently and…
This rule proposes a standard for a national health careprovider identifier and requirements concerning its use by health plans, health care clearinghouses, and health careproviders. The health plans, health care clearinghouses, and health careproviders would use the identifier, among other uses, in connection with certain electronic transactions. The use of this identifier would improve the Medicare and Medicaid programs, and other Federal health programs and private health programs, and the effectiveness and efficiency of the health care industry in general, by simplifying the administration of the system and enabling the efficient electronic transmission of certain health information. It would implement some of the requirements of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996. PMID:10179329
Objectives: To determine the prevalence of prevention counseling discussions between HIV careproviders and their patients who are newly linked to care and to assess factors that facilitate such discussions. Methods: In 2009, a probability sample of HIV careproviders in 582 outpatient settings in the United States and Puerto Rico was surveyed regarding provider's HIV prevention discussions with HIV-infected patients newly linked to HIV medical care. Results: A majority of providers reported consistently discussing HIV transmission risk reduction (76%), sexually transmitted disease risk (66%), and adherence to antiretroviral regimens (87%). Only 35% of providers reported consistently discussing partner counseling services. Conclusion: The proportion of providers engaged in HIV prevention counseling with patients newly linked to HIV care is generally high, but more work is needed to encourage providers to fully participate as partners in prevention, which is central to preventing onward transmission of HIV. PMID:24429103
Valverde, Eduardo; Beer, Linda; Johnson, Christopher; Blair, Janet M; Mattson, Christine L; Sanders, Catherine; Weiser, John; Skarbinski, Jacek
The use of complementary and alternative medicine (CAM) has grown in popularity both among the general population and among the cancer patients. Cancer patients often use CAM, which is a treatment that is not commonly used in the conventional setting. However, the prevalence of CAM use appears to vary substantially, with reported frequency of use of at least one CAM therapy ranging from 20% to 83.3%. Complementary medicine has become an important aspect of palliative cancercare. Acupuncture, aromatherapy, homeopathy, hypnotherapy, massage, reflexology, relaxation techniques, and spiritual healing are frequently used forms of treatment. The purpose of this article is to provide information about some complementary therapies that are commonly used by cancer patients in the palliative care. PMID:16783665
Cancercare is increasingly complex, and as many as one in five cancer patients may experience "breakdowns" in their care, according to a new study in the Journal of Clinical Oncology. Such breakdowns include communication problems between patients and their careproviders, as well as more traditional medical errors; both types of problems can create significant harms. In the study, communication problems outnumbered problems with medical care.
These guidelines are the product of a new Pediatric Asthma Initiative aimed at integrating environmental management of asthma into pediatric health care. This document outlines competencies in environmental health relevant to pediatric asthma that should be mastered by primary health careproviders, and outlines the environmental interventions…
The establishment in recent years of a National Provider Identifier (NPI) offers a new method for counting and categorizing physicians and other health care professionals involved in clinical care. In this paper, I describe how the NPI is assigned, the information collected in association with assigning the NPI, potential ways to enhance information on health professionals through data linkages using the NPI, and how the assessment of the health care workforce could be improved by requiring health care professionals to update their information as a part of maintaining their NPI. PMID:24753977
The establishment in recent years of a National Provider Identifier (NPI) offers a new method for counting and categorizing physicians and other health care professionals involved in clinical care. In this paper, I describe how the NPI is assigned, the information collected in association with assigning the NPI, potential ways to enhance information on health professionals through data linkages using the NPI, and how the assessment of the health care workforce could be improved by requiring health care professionals to update their information as a part of maintaining their NPI.
Individuals at high risk for hereditary cancers often receive genetic counseling and testing at tertiary care centers; however,\\u000a they may receive care for long-term management of their cancer risk in community settings. Communication of genetic test results\\u000a to health careproviders outside of tertiary care settings can facilitate the long-term management of high risk individuals.\\u000a This study assessed women’s communication
K. Ready; B. K. Arun; K. M. Schmeler; A. Uyei; J. K. Litton; K. H. Lu; C. C. Sun; S. K. Peterson
The Institute of Medicine's (IOM) Committee on Improving the Quality of CancerCare: Addressing the Challenges of an Aging Population was charged with evaluating and proposing recommendations on how to improve the quality of cancercare, with a specific focus on the aging population. Based on their findings, the IOM committee recently released a report highlighting their 10 recommendations for improving the quality of cancercare. Based on those recommendations, this article highlights ways to improve evidence-based care and addresses rising costs in health care for older adults with cancer. The IOM highlighted three recommendations to address the current research gaps in providing evidence-based care in older adults with cancer, which included (1) studying populations which match the age and health-risk profile of the population with the disease, (2) legislative incentives for companies to include patients that are older or with multiple morbidities in new cancer drug trials, and (3) expansion of research that contributes to the depth and breadth of data available for assessing interventions. The recommendations also highlighted the need to maintain affordable and accessible care for older adults with cancer, with an emphasis on finding creative solutions within both the care delivery system and payment models in order to balance costs while preserving quality of care. The implementation of the IOM's recommendations will be a key step in moving closer to the goal of providing accessible, affordable, evidence-based, high-quality care to all patients with cancer. PMID:24857069
... Talk With Your Health CareProvider About High Cholesterol Partnership for HEALTH Here are some questions to ... prevention.va.gov and April 2009 If your cholesterol is in the desirable range and you are ...
Background. This pilot study explored health careproviders' perceptions of barriers to providing health care services to Somali refugee women. The specific aim was to obtain information about providers' experiences, training, practices and attitudes surrounding the prenatal care, delivery, and management of women with Female Genital Cutting (FGC). Methods. Individual semi-structured interviews were conducted with 14 obstetricians/gynecologists and nurse midwives in Columbus, Ohio. Results. While providers did not perceive FGC as a significant barrier in itself, they noted considerable challenges in communicating with their Somali patients and the lack of formal training or protocols guiding the management of circumcised women. Providers expressed frustration with what they perceived as Somali patients' resistance to obstetrical interventions and disappointment with a perception of mistrust from patients and their families. Conclusion. Improving the clinical encounter for both patients and providers entails establishing effective dialogue, enhancing clinical and cultural training of providers, improving health literacy, and developing trust through community engagement.
The work in family child care is becoming increasingly more professional, moving from an image of ‘mothering’ toward one of\\u000a educare. The growing demand for expertise and competence in family child careproviders can be examined in light of their\\u000a pedagogical experiences and the ways in which children engage in learning in providers’ homes. This article is based on a
Pregnant farmworkers and their fetuses are at increased risk of negative health outcomes due to environmental and occupational factors at their workplaces. Health careproviders who serve farm communities can positively affect workers' health through the informed care they deliver. Yet, interviews with rural health careproviders reveal limited knowledge about agricultural work or occupational and environmental health risks during pregnancy. Professional associations, government organizations, academic institutions, and practice settings must renew their efforts to ensure that environmental and occupational health education, especially as it relates to women and their children, is incorporated into academic and practice environments. PMID:23799657
Kelley, Maureen A; Flocks, Joan D; Economos, Jeannie; McCauley, Linda A
The high risk for recidivism among sex offenders who need long term care (LTC) raises serious issues when they are cared for alongside frail, vulnerable adults. LTC providers must balance offenders' right to access care with other residents' right to be free from abuse and must assess and manage the risks associated with admitting offenders. This article identifies sources of legal liability that derive from sex offender management and discusses the need for the LTC community to develop reasonable, balanced guidance on how best to mitigate the risks associated with sex offenders, protect the rights of all residents, and reduce provider liabilities. PMID:24094899
Quality of life is as important as quantity of life, if not more. In some life-threatening diseases, the possibility of cure is sometimes poor, and symptoms of the disease reduce the quality of life too. Improvement of symptoms helps the patients to live more comfortably while allowing them to retain their autonomy and dignity despite the life-threatening disease. The total care of such patients, helping them to live as well as possible in spite of their symptoms forms the basis of palliative care. Palliative care is an upcoming discipline, which aims to provide comfort to patients suffering from severe disease-related discomfort. It is not end-of-life support, as previously thought but is recommended to be integrated with therapy right from diagnosis. Studies conducted overseas show that when introduced early, palliative care leads to better outcomes of curative therapies, while making the patient comfortable and pain-free. There are different models and methods of delivery of palliative care and the involvement of family in the care of the patient produces the best outcome. Palliative care can be delivered both at a dedicated centre as well as at the patient's home, depending on the preferences of the patient. This paper discusses the efforts towards providingcare for patients in different stages of cancer therapy. PMID:24968527
Kulkarni, Priyadarshini; Ghooi, Ravindra; Vijayakumar, K
The authors report the results of a symposium on improving the standards of care for patients with cancer pain. The symposium was sponsored by the Advisory Committee on Cancer Control of the National Cancer Institute of Canada and was held Apr. 8 to 10, 1994, in Toronto. Participants included experts on control of cancer pain and on diffusion techniques, patients with cancer and representatives of regulatory agencies. They suggested the following strategies to improve outcomes in patients with cancer pain. Processes for accreditation of health care institutions should require documentation of cancer pain, its treatment and its outcome. Tertiary care facilities that providecancer treatment should have expert, subspecialty, multidisciplinary programs for pain control and should provide adequate psychosocial support to patients suffering cancer pain. The Canadian Cancer Society should conduct a public-education campaign to encourage patients to report pain to health careproviders. The National Cancer Institute of Canada should foster research on cancer pain by restructuring its process for review of pain-research protocols. Examinations for professionals who care for patients with cancer should include a defined number of questions concerning pain and symptom control. Provincial programs to monitor prescribing through the use of triplicate prescription pads should have an educational as well as regulatory purpose.
Licensed and unlicensed providers of child care in Virginia were asked about their training needs. Responses revealed that providers have little time for themselves and their families, and therefore, innovative training methods must be planned to deliver programs that will fit into their lifestyles. It was also found that new providers needed an…
In the delivery of medical and surgical care, often times complex interactions between patient, physician, and hospital factors influence practice patterns. This paper presents a novel application of logic regression in the context of kidney cancer treatment delivery. Using linked data from the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) program and Medicare we identified patients diagnosed with kidney cancer from 1995 to 2005. The primary endpoints in the study were use of innovative treatment modalities, namely, partial nephrectomy and laparoscopy. Logic regression allowed us to uncover the interplay between patient, provider, and practice environment variables, which would not be possible using standard regression approaches. We found that surgeons who graduated in or prior to 1980 despite having some academic affiliation, low volume surgeons in a non-NCI hospital, or surgeons in rural environment were significantly less likely to use laparoscopy. Surgeons with major academic affiliation and practising in HMO, hospital, or medical school based setting were significantly more likely to use partial nephrectomy. Results from our study can show efforts towards dismantling the barriers to adoption of innovative treatment modalities, ultimately improving the quality of careprovided to patients with kidney cancer.
Banerjee, Mousumi; Filson, Christopher; Xia, Rong; Miller, David C.
Lung cancer is the commonest cause of cancer-related death worldwide and poses a significant respiratory disease burden. Little is known about the provision of lung cancercare across Europe. The overall aim of the Task Force was to investigate current practice in lung cancercare across Europe. The Task Force undertook four projects: 1) a narrative literature search on quality management of lung cancer; 2) a survey of national and local infrastructure for lung cancercare in Europe; 3) a benchmarking project on the quality of (inter)national lung cancer guidelines in Europe; and 4) a feasibility study of prospective data collection in a pan-European setting. There is little peer-reviewed literature on quality management in lung cancercare. The survey revealed important differences in the infrastructure of lung cancercare in Europe. The European guidelines that were assessed displayed wide variation in content and scope, as well as methodological quality but at the same time there was relevant duplication. The feasibility study demonstrated that it is, in principle, feasible to collect prospective demographic and clinical data on patients with lung cancer. Legal obligations vary among countries. The European Initiative for Quality Management in Lung CancerCare has provided the first comprehensive snapshot of lung cancercare in Europe. PMID:24659546
Providing health care for a woman with a surrogate pregnancy involves unique challenges. Although the ethical debate surrounding surrogacy continues, Canada has banned commercial, but not altruistic, surrogacy. In the event of a custody dispute between a surrogate mother and the individual(s) intending to parent the child, it is unclear how Canadian courts would rule. The prenatal health careprovider must take extra care to protect the autonomy and privacy rights of the surrogate. There is limited evidence about the medical and psychological risks ofsurrogacy. Whether theoretical concerns about these risks are clinically relevant remains unknown. In the face of these uncertainties, the prenatal health careprovider should have a low threshold for seeking obstetrical, social work, ethical and legal support.
We know little about Mexican-American (MA) family adaptation to critical events in the informal caregiving experience but, in these days of economic and social turmoil, sons must sometimes step up to provide personal care for their aging mothers. This article compares two empirically real cases of MA males who provided such care, in lieu of a female relative. The cases are selected from a federally-funded, descriptive, longitudinal, mixed methods study of 110 MA caregivers and their care recipients. In case-oriented research, investigators can generate propositions (connected sets of statements) that reflect their findings and conclusions, and can be tested against subsequent cases: Caregiving strain and burden in MA males may have more to do with physical and emotional costs than financial ones; MA males providing personal care for their mothers adopt a matter-of-fact approach as they act “against taboo”; and this approach is a new way to fulfill family obligations.
Evans, Bronwynne C.; Belyea, Michael J.; Ume, Ebere
Many cancer treatments induce gonadal failure, which can cause infertility and menopausal symptoms in women. Improvements in treatments for hematologic malignancies have extended survival, thus making treatment-induced gonadal failure (TIGF) a more widespread problem. We reviewed the published literature on TIGF with the goal of providing practical information for health-careproviders engaged in the management of hematologic malignancies. We conclude
Kazutaka Nakayama; Andrea Milbourne; Leslie R Schover; Richard E Champlin; Naoto T Ueno
Human trafficking is a major public health problem, both domestically and internationally. Health careproviders are often the only professionals to interact with trafficking victims who are still in captivity. The expert assessment and interview skills of providers contribute to their readiness to identify victims of trafficking. The purpose of this article is to provide clinicians with knowledge on trafficking and give specific tools that they may use to assist victims in the clinical setting. Definitions, statistics, and common health care problems of trafficking victims are reviewed. The role of the health careprovider is outlined through a case study and clinical practice tools are provided. Suggestions for future research are also briefly addressed. PMID:20732668
Human trafficking is a major public health problem, both domestically and internationally. Health careproviders are often the only professionals to interact with trafficking victims who are still in captivity. The expert assessment and interview skills of providers contribute to their readiness to identify victims of trafficking. The purpose of this article is to provide clinicians with knowledge on trafficking and give specific tools that they may use to assist victims in the clinical setting. Definitions, statistics, and common health care problems of trafficking victims are reviewed. The role of the health careprovider is outlined through a case study and clinical practice tools are provided. Suggestions for future research are also briefly addressed.
Aims: The aim of the current study was to explore the extent of knowledge health careproviders working in primary health care units in Aydin, Turkey, had about emergency contraception (EC), to determine whether they provide EC counseling, and to understand the barriers and misconceptions in this context. Methods: A total of 120 health care professionals working in primary health
Several major policy reports describe the central role of primary care in improving the delivery of behavioral health care services to children and adolescents. Although primary careproviders are uniquely positioned to provide these services, numerous obstacles hinder the integration of these services, including time, clinic management and organization issues, training, and resources. Although many of these obstacles have been
George W. Bitar; Paul Springer; Robert Gee; Chad Graff; Manuel Schydlower
Chiropractors have the potential to address a substantial portion of spinal disorders; however the utilization rate of chiropractic services has remained low and largely unchanged for decades. Other health care professions such as podiatry/chiropody, physiotherapy and naturopathy have successfully gained public and professional trust, increases in scope of practice and distinct niche positions within mainstream health care. Due to the overwhelming burden of spine care upon the health care system, the establishment of a 'primary spine careprovider' may be a worthwhile niche position to create for society's needs. Chiropractors could fulfill this role, but not without first reviewing and improving its approach to the management of spinal disorders. Such changes have already been achieved by the chiropractic profession in Switzerland, Denmark, and New Mexico, whose examples may serve as important templates for renewal here in Canada. PMID:24302774
Erwin, W Mark; Korpela, A Pauliina; Jones, Robert C
Chiropractors have the potential to address a substantial portion of spinal disorders; however the utilization rate of chiropractic services has remained low and largely unchanged for decades. Other health care professions such as podiatry/chiropody, physiotherapy and naturopathy have successfully gained public and professional trust, increases in scope of practice and distinct niche positions within mainstream health care. Due to the overwhelming burden of spine care upon the health care system, the establishment of a ‘primary spine careprovider’ may be a worthwhile niche position to create for society’s needs. Chiropractors could fulfill this role, but not without first reviewing and improving its approach to the management of spinal disorders. Such changes have already been achieved by the chiropractic profession in Switzerland, Denmark, and New Mexico, whose examples may serve as important templates for renewal here in Canada.
Erwin, W. Mark; Korpela, A. Pauliina; Jones, Robert C.
The authors describe design, implementation, and use of a new order entry system module for neonatal intensive care. WizOrder is a Computerized Provider Order Entry (CPOE) system developed at Vanderbilt University Medical Center. Since WizOrder's introduction in 1995, it has been continually refined and enhanced; especially when new hospital units and specialties are implemented. Recently, in March 2003, WizOrder was updated and implemented in the Neonatal Intensive Care Unit (NICU). PMID:14728581
This book provides practical information and advice designed to help family day careproviders solve problems they confront in their daily work with children. The book is organized into 7 sections. Part I, "Effective Ways to Change Unacceptable Behavior," offers recommendations about discipline, alternatives to punishment, modeling, and praise.…
This study describes patterns of choosing a provider and of consumer satisfaction among prepaid Medicaid beneficiaries in Monroe County, New York, and compares their level of satisfaction to that of fee-for-service Medicaid beneficiaries. Two interview surveys were conducted with AFDC and HR (general assistance) Medicaid eligibles, the first under the fee-for-service system servicing the Medicaid population, and the second 18 months after the introduction of a mandatory, prepaid managed care system for Medicaid beneficiaries. The results show significant ethnic differences in patient choice of provider and provider site. Given the choice, Medicaid beneficiaries switch from clinics as their usual source of care to private physician practice. Under prepayment, white Medicaid beneficiaries tripled their affiliations with private doctors, while "others" doubled theirs. The results also demonstrate higher levels of patient satisfaction with "humaneness of doctors" and with "quality of care" among those beneficiaries under prepaid care, than previously documented for those under fee-for-service. The evaluations of humaneness and quality of medical system may reflect the respondents' perceptions that the process of receiving care under prepaid, managed care is somehow different, no longer second class, and better that it was under the fee-for-service Medicaid.
Objectives This article describes successful institutionally-based programs for providing high quality palliative care to people with cancer and their family members. Challenges and opportunities for program development are also described. Data Sources Published literature from 2000 to present describing concurrent oncology palliative care clinical trials, standards and guidelines were reviewed. Conclusion Clinical trials have demonstrated feasibility and positive outcomes and formed the basis for consensus guidelines that support concurrent oncology palliative care models. Implications for nursing practice Oncology nurses should advocate for all patients with advanced cancer and their families to have access to concurrent oncology palliative oncology care from the time of diagnosis with a life-limiting cancer.
Bakitas, Marie; Bishop, Margaret Firer; Caron, Paula; Stephens, Lisa
Describes the transformation of women from babysitters to child care professionals as a result of becoming a family child careprovider in the U.S. military Family Child Care (FCC) program. Discusses application process, orientation training, the use of peer mentors, initial setup, inspections, enrollment, caregiver training, and accreditation.…
This reference manual and resource guide describes high standards for health policies and day care procedures that reflect current research and recommendations of experts. Chapters 1 and 2, which concern day care's role in health, cover health education in day care and the basics relating to policies, providers, and records. Chapters 3-5 concern…
Drawing on in-depth interviews with 20 family child careproviders of diverse race, ethnicity, immigrant status, and social class, this book explores the social, political, and economic forces and processes that draw women into the work of family child care. The articles dispel not only myths about why women choose to be family child care…
Commoditization pressures in medicine have risked transforming service provider selection from "survival of the fittest" to "survival of the cheapest." Quality- and safety-oriented mandates by the Institute of Medicine have led to the creation of a number of data-driven quality-centric initiatives including Pay for Performance and Evidence-Based Medicine. A synergistic approach to creating quantitative accountability in medical service delivery is through the creation of consumer-oriented performance metrics which provide patients with objective data related to individual service provider quality, safety, cost-efficacy, efficiency, and customer service. These performance metrics could in turn be customized to the individual preferences and health care needs of each individual patient, thereby providing an objective methodology for service provider selection while empowering health care consumers. PMID:21468775
Primary careproviders (PCPs) usually do not explore patient suicidality during routine visits. Factors that predict PCP attitudes toward the assessment and treatment of suicidality were examined via an online survey of 195 practicing PCPs affiliated with medical schools in the United States. PCPs who perceived themselves as competent to work with…
Introduction: A continuing education (CE) program based on the theory of planned behavior was designed to understand and improve health careproviders' practice patterns in screening, assessing, and treating and/or referring patients with diabetes for depression treatment. Methods: Participants completed assessments of attitudes, confidence,…
Purpose: To define hearing loss (HL), discuss the impact of HL on child development, and review the literature on cochlear implantation in children. The criteria for and the benefits and limitations of cochlear implantation in children, as well as the implications for the primary careprovider with regard to children who have cochlear implants, are presented. Data sources: Review of
China has one of the fastest growing HIV epidemics in the world with an increase in reported cases of about 30% yearly (UNAIDS, 2004). As the epidemic has grown, there have been several studies of health careprovider attitudes towards HIV in China over the last 15 years. While attitudes have evolved, misconceptions about transmission of HIV, low levels of
Introduction: Routine screening for intimate partner violence (IPV) is endorsed by numerous health professional organizations. Screening rates in health care settings, however, remain low. In this article, we present a review of studies focusing on provider-specific barriers to screening for IPV and interventions designed to increase IPV screening in clinical settings.Methods: A review of published studies containing original research with
Jill Waalen; Mary M Goodwin; Alison M Spitz; Ruth Petersen; Linda E Saltzman
A Title XX funded statewide training program offering 20 hours of instruction for 1,662 licensed center and home child careproviders who served Title XX eligible children in Michigan was evaluated at the end of its first year of operation. The first three chapters of this evaluation report discuss (1) the history, philosophy, and goals of the…
Introduction Older hip fracture patients frequently require care across a variety of settings, from multiple individuals, including their family caregivers. We explored issues related to information sharing during transitional care for older hip fracture patients through the perspectives of both health careproviders and family caregivers. Methods Thirty-five semi-structured interviews were conducted with family caregivers (n = 9) and health careproviders (n = 26) of six hip fracture patients to gather perspectives on information sharing at each care transition, beginning with post-surgical discharge from acute care. Data were analysed using conventional qualitative content analysis methods using NVivo8 software. Results Both family caregivers and health careproviders recognise that family caregivers' involvement has important benefits for patients, but this involvement is frequently limited by poor information sharing. Barriers include limited staff time, patient privacy regulations and lack of a clear structure to guide information sharing. Receiving, not offering, information was the focus of information sharing by both family caregivers and health careproviders. Conclusions Specific barriers that lead to poor information sharing between family caregivers and health careproviders have been identified in this study. Possible interventions to improve information sharing include encouraging communication with family caregivers as standard care practice, educational strategies and more effective use of health information systems and technologies.
Glenny, Christine; Stolee, Paul; Sheiban, Linda; Jaglal, Susan
Purpose Research suggests that physicians neglect preventive care for cancer survivors. A survivor’s self-motivation with respect to preventive care is unknown. Using protective skin care as a proxy, our aims were to characterize preventive care in cancer survivors and to identify factors associated with appropriate prevention. Methods Using data from the 2009 U.S. Health Information National Trends Survey, we compared preventive skin care patterns in cancer survivors and non-cancer patients. Primary endpoints were the use of sunscreens, long-sleeved shirts, hats, and shade. Results We identified 179 early cancer survivors (<5 years), 242 intermediate cancer survivors (5–10 years), 412 long-term cancer survivors (>10 years), and 5951 non-cancer patients. The use of sunscreens (60%), long-sleeved shirts (88%), hats (58%), and shade (68%) was suboptimal. Overall, cancer survivors were not more likely to adhere to preventive care (p = 0.89). A composite score showed a significant difference between the cancer survivor groups (p < 0.01) whereby intermediate survivors reported the best preventive practices. Conclusions A prior diagnosis of cancer does not appear to increase personal compliance with cancer prevention. Reasons for this poor engagement are not clear. Targeted strategies to increase self-motivation might improve preventive practices in cancer survivors.
Overall, there has been tremendous movement over the last decade toward centralization of cancercare into specialized centers. This comes from the recognition that multidisciplinary care, including access to opinions from gynecologic, medical, and radiation oncologists, can improve patient outcomes. In addition to this input, it is important to have access to subspecialty pathology, diagnostic radiology, oncology nursing, and other disciplines as necessary. The population-based literature on quality of care in gynecologic cancers reflects this movement, with many articles evaluating outcomes in terms of structural variables. However, the continued presence of regional and sociodemographic variation in outcomes suggests it is still possible to achieve significant improvements in survival by concentrating efforts to improve the quality of careprovided to gynecologic cancer patients. Improved outcomes for patients with ovarian cancer can be achieved by continued centralization of gynecologic cancercare and provision of care by gynecologic oncologists in high-volume centers. Further study is needed to determine if cervical cancer and vulvar cancer outcomes can be improved with centralization. For uterine cancer, at this time there do not appear to be significant improvements in outcomes related to centralization.For all gynecologic cancers, more attention should be paid to the processes of care and their impact on patient outcomes. An appropriate goal for all health care systems is to ensure all women have access to evidence-based care. This is particularly important for high-risk women, older women, and minority women, who suffer a disproportionate amount of the gynecologic cancer–related mortality and often do not receive evidence-based care. Clinical practice guidelines exist to provide guidance to clinicians as to what constitutes evidence-based care and to make recommendations concerning current best practices. Adherence to guidelines can help to reduce variations in care due to sociodemographic factors. As the provision of cancercare becomes more and more centralized, outcomes at the population level will be improved only by focusing on the processes of care. A look at the three North American health care systems shows there are issues with women having access to high-quality, timely care. This fundamental problem must be addressed to systematically improve health at the population level. Governments should strive toward the WHO goal of promoting health development in their populations by reducing inequalities in the access to health care and health promotion activities. PMID:22640706
PRIMARY CAREPROVIDERS SHOULD BE AWARE OF TWO NEW DEVELOPMENTS IN NICOTINE ADDICTION AND SMOKING CESSATION: 1) the emergence of a novel nicotine delivery system known as the electronic (e-) cigarette; and 2) new reports of residual environmental nicotine and other biopersistent toxicants found in cigarette smoke, recently described as "thirdhand smoke". The purpose of this article is to provide a clinician-friendly introduction to these two emerging issues so that clinicians are well prepared to counsel smokers about newly recognized health concerns relevant to tobacco use. E-cigarettes are battery powered devices that convert nicotine into a vapor that can be inhaled. The World Health Organization has termed these devices electronic nicotine delivery systems (ENDS). The vapors from ENDS are complex mixtures of chemicals, not pure nicotine. It is unknown whether inhalation of the complex mixture of chemicals found in ENDS vapors is safe. There is no evidence that e-cigarettes are effective treatment for nicotine addiction. ENDS are not approved as smoking cessation devices. Primary care givers should anticipate being questioned by patients about the advisability of using e-cigarettes as a smoking cessation device. The term thirdhand smoke first appeared in the medical literature in 2009 when investigators introduced the term to describe residual tobacco smoke contamination that remains after the cigarette is extinguished. Thirdhand smoke is a hazardous exposure resulting from cigarette smoke residue that accumulates in cars, homes, and other indoor spaces. Tobacco-derived toxicants can react to form potent cancer causing compounds. Exposure to thirdhand smoke can occur through the skin, by breathing, and by ingestion long after smoke has cleared from a room. Counseling patients about the hazards of thirdhand smoke may provide additional motivation to quit smoking. PMID:21475626
Kuschner, Ware G; Reddy, Sunayana; Mehrotra, Nidhi; Paintal, Harman S
At some point in many children's lives, parents are faced with the difficult question, "What about child care?" Intended for both parents and providers, this guide is designed to help parents decide whether family child care is suited to their needs, guiding them through the process of choosing a provider and allowing them a look behind the scenes…
Recognizing the importance of maintaining a safe and healthy child care setting, this manual for home or center child careproviders contains information and guidelines to help providers maintain child health and reduce sickness and injuries. Part 1, "Introduction," describes how diseases are spread and how to prevent and prepare for unintentional…
Identifies three major areas of concern in relationship between health careproviders and dying patients: (1) nature of difficulties and stresses associated with terminal care; (2) education of providers for work; and (3) influence of organizational structure and institutionalized values on services for dying patients and families. Reviews…
The rapid transformation of primary care in the United States provides an opportunity for psychologists to become actively involved as integrated members of primary care teams in the provision of services for adults with chronic disease. The differences between primary care clinicians and psychologists with respect to education, culture, practice styles, reimbursement, and roles, however, pose notable barriers to effective integration. In this report we review models of collaboration, barriers to effective integration of services, and potential areas in which psychologists can make major contributions both to direct service delivery and to primary care practice, with special reference to the care of adults with chronic conditions. PMID:24820685
Quality cancer treatment depends upon careful coordination between multiple treatments and treatment providers, the exchange of technical information, and regular communication between all providers and physician disciplines involved in treatment. This article will examine a particular type of organizational structure purported to regularize and streamline the communication between multiple specialists and support services involved in cancer treatment: the multidisciplinary treatment care (MDC) team. We present a targeted review of what is known about various types of MDC team structures and their impact on the quality of treatment care, and we outline a conceptual model of the connections between team context, structure, process, and performance and their subsequent effects on cancer treatment care processes and patient outcomes. Finally, we will discuss future research directions to understand how MDC teams improve patient outcomes and how characteristics of team structure, culture, leadership, and context (organizational setting and local environment) contribute to optimal multidisciplinary cancercare.
Prabhu Das, Irene; Clauser, Steven; Petrelli, Nicholas; Salner, Andrew
Adolescents and young adults with cancer are a heterogeneous group. Management of this special group requires a broad-based interdisciplinary clinical team, which should include palliative care (PC), psychology, social work, oncology, and nursing representatives. The function of PC is to provide impeccable pain and other symptom control and to coordinate care as the disease progresses. The cure rate of cancer in adolescents is high but between 10% and 40% of them will develop incurable disease depending on tumor type and prognostic factors. PC in adolescents should also take care of the specific physical and psychosocial developmental changes in this age group. A 16-year old boy suffered with incurable disease and team has provided the PC at the door step taken as a case study.
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...Enter Into Provider Agreements for Extended Care Services AGENCY: Department of Veterans...provider agreements to obtain extended care services from non-VA providers. In addition...rulemaking proposes to include home health care, palliative care, and...
Background Asthma outcomes are generally worse for ethnic minority children. Cultural competence training is an instrument for improving healthcare for ethnic minority patients. To develop effective training, we explored the mechanisms in paediatric asthma care for ethnic minority patients that lead to deficiencies in the care process. Methods We conducted semi-structured interviews on care for ethnic minority children with asthma (aged 4-10 years) with paediatricians (n?=?13) and nurses (n?=?3) in three hospitals. Interviews were analysed qualitatively with a framework method, using a cultural competence model. Results Respondents mentioned patient non-adherence as the central problem in asthma care. They related non-adherence in children from ethnic minority backgrounds to social context factors, difficulties in understanding the chronic nature of asthma, and parents’ language barriers. Reactions reported by respondents to patients’ non-adherence included retrieving additional information, providing biomedical information, occasionally providing referrals for social context issues, and using informal interpreters. Conclusions This study provides keys to improve the quality of specialist paediatric asthma care to ethnic minority children, mainly related to non-adherence. Careproviders do not consciously recognise all the mechanisms that lead to deficiencies in culturally competent asthma care they provide to ethnic minority children (e.g. communicating mainly from a biomedical perspective and using mostly informal interpreters). Therefore, the learning objectives of cultural competence training should reflect issues that careproviders are aware of as well as issues they are unaware of.
The purpose of this article was to provide a historical review and analysis of the research literature focusing on patients', nurses', and health careproviders' perceptions of stressors in the critical care setting. A narrative historical literature review method was used. The inclusion criteria include English-language studies of stressors as perceived by patients and health careproviders from 1984 to 2011. Several studies investigated perceptions of stressors using the Environmental Stressors Questionnaire and the findings did not show any significant changes of stress perception over time since 1989 until the present. There is a need to further investigate stress perceptions in the health care setting using a mixed qualitative and quantitative approach to provide a more precise description of stressors and stress perceptions in the critical care setting. PMID:23222224
Colon cancer therapies have improved patient outcomes significantly over the last decades in both the adjuvant and metastatic settings. With the introduction of a number of novel agents, both traditional chemotherapies and biologically targeted agents, the need to identify subgroups that are likely and not likely to respond to a particular treatment regimen is paramount. This will allow patients who are likely to benefit to receive optimal care, while sparing those unlikely to benefit from unnecessary toxicity and cost. With the identification of several novel biomarkers and a variety of technologies to interrogate the genome, we are already able to rapidly study patient tumor or blood samples and normal tissues to generate a large dataset of aberrations within the cancer. How to digest this complex information to obtain accurate, reliable, and meaningful results that will allow us to provide truly personalized care for colon cancer patients is just starting to be addressed. In this article, we briefly review the history of colon cancer treatment, with an emphasis on current clinical standards that incorporate a ‘personalized medicine’ approach. We then review strategies which will potentially improve our ability to individualize therapy in the future.
Catenacci, Daniel V.T.; Kozloff, Mark; Kindler, Hedy L.; Polite, Blase
Introduction A Continuing Education (CE) program based on the theory of planned behavior was designed to understand and improve health careproviders’ practice patterns in screening, assessing, and treating and/or referring patients with diabetes for depression treatment. Methods Participants completed assessments of attitudes, confidence, intentions, and behaviors regarding depression management at three time points: immediately prior to the CE program (baseline), immediately after the CE program (posttest) and six-weeks after the CE program (follow-up). Results Ninety eight providers attended the CE program; 71 completed the baseline assessment; 66 completed the posttest assessment, and 37 completed the 6-week follow-up. Compared to baseline, at posttest providers reported significantly more favorable attitudes, fewer negative attitudes, greater confidence, and greater intention to address depression with their diabetes patients. At six weeks follow-up, there was a marginally significant increase in educating patients about depression, but no other depression management practices changed. Intention to change and confidence predicted some depression practice patterns at follow-up. Fewer barriers were a consistent predictor of depression practice patterns at follow-up. Discussion In the short-term, provider attitudes, confidence, and intentions to address depression with their patients improved. Intention, confidence, and especially barriers are important intervention targets. Lessons for Practice Depression is a common comorbidity of diabetes. Healthcare providers must be better prepared to manage depression in their diabetes patients. Educating health professionals is one approach to improving depression care. Healthcare systems must address barriers to providers’ efforts to manage depression. Continuing education programs should aim to enhance providers’ intentions, confidence, and skills to overcome barriers to addressing depression in clinical care.
Synopsis The Individualized Care Planning and Coordination Model is designed to integrate palliative care principles and practices into the ongoing care of children with cancer. Application of the model helps clinicians to generate a comprehensive individualized care plan that is implemented through Individualized Care Coordination processes as detailed here. Clinicians’ strong desire to provide compassionate, competent and sensitive care to the seriously ill child and the child’s family can be effectively translated into clinical practice through these processes. “To cure sometimes, to relieve often, to comfort always -- this is our work.” Author Unknown
Baker, Justin N; Hinds, Pamela S; Spunt, Sheri L; Barfield, Raymond C; Allen, Caitlin; Powell, Brent C; Anderson, Lisa H; Kane, Javier R
Within Europe, although there are numerous examples of poor co-ordination in the delivery of integrated care, many providers do co-operate. We wanted to know why providers are moved to co-operate. In terms of systematic research, this is a new field; researchers have only begun to theorise about the rationales for co-operation. Practically, the issue of achieving co-operation attracts much attention from policymakers. Understanding the reasons for co-operation is a prerequisite for developing effective policy in support of integrated care. Our aim is to explore the comparative validity of different theoretical perspectives on the reasons for co-operation, to indicate directions for further study and for policy making. We used data from three successive studies to perform pattern matching with six established theoretical perspectives: transaction costs economics, strategic choice theory, resource dependence theory, learning theory, stakeholder theory and institutional theory. Insights from the studies were compared for validating purposes (triangulation). The first study concerned the evaluation of the Dutch 'National Home Health Care Programme' according to the case study methodology. The second and third studies were surveys among project directors: questionnaires were based on the concepts derived from the first study. Researchers should combine normative institutional theory, resource dependence theory and stakeholder theory into one perspective, in order to study relationship formation in health and social care. The concept of institutions (rules) is the linchpin between the theories. Policy makers must map the institutions of stakeholders and enable integrated care policy to correspond with these institutions as much as possible. PMID:16098408
Bangladesh is a developing country that is facing many challenges, especially in the health sector. Cancer management is a priority due to the current trend of increased incidence in this region. In this article, the current scenario of cancer in Bangladesh and its management with brief history is outlined. The combined effort of government and private sector is highlighted with the gradual progress in cancer management. Recent introduction of the state-of-the-art facilities and the training facilities for human resource development are also outlined. The existing challenges and cooperation from local NGOs and other overseas sources are also highlighted to provide an insight regarding possible ways to tackle these challenges to ensure a better future.
Uddin, A. F. M. Kamal; Khan, Zohora Jameela; Islam, Johirul; Mahmud, AM
Research findings concerning the role of gender in patient-physician interactions can inform considerations about the role of gender in patient-dental careprovider interactions. Medical research showed that gender differences in verbal and nonverbal communication in medical settings exist and that they affect the outcomes of these interactions. The process of communication is shaped by gender identities, gender stereotypes, and attitudes. Future research needs to consider the cultural complexity and diversity in which gender issues are embedded and the degree to which ongoing value change will shape gender roles and in turn interactions between dental patients and their providers. PMID:23570810
Given the absence of effective population-based screening tests for ovarian, uterine, vaginal, and vulvar cancers, early detection can depend on women and health careproviders recognizing the potential significance of symptoms. In 2008, the Centers for Disease Control and Prevention's (CDC) Inside Knowledge campaign began distributing consumer education materials promoting awareness of gynecologic cancer symptoms. We investigated providers' in-office use of CDC gynecologic cancer materials and their recognition of the symptoms highlighted in the materials. We analyzed data from a national 2012 survey of US primary care physicians, nurse practitioners, and gynecologists (N?=?1,380). Less than a quarter of providers (19.4 %) reported using CDC gynecologic cancer education materials in their offices. The provider characteristics associated with the use of CDC materials were not consistent across specialties. However, recognition of symptoms associated with gynecologic cancers was consistently higher among providers who reported using CDC materials. The possibility that providers were educated about gynecologic cancer symptoms through the dissemination of materials intended for their patients is intriguing and warrants further investigation. Distributing consumer education materials in health careprovider offices remains a priority for the Inside Knowledge campaign, as the setting where women and health careproviders interact is one of the most crucial venues to promote awareness of gynecologic cancer symptoms. PMID:24214840
Introduction Complex older adults, such as those with hip fracture, frequently require care from multiple professionals across a variety of settings. Integrated care both between providers and across settings is important to ensure care quality and patient safety. The purpose of this study was to determine the core factors related to poorly integrated care when hip fracture patients transition between care settings. Methods A qualitative, focused ethnographic approach was used to guide data collection and analysis. Patients, their informal caregivers and health careproviders were interviewed and observed at each care transition. A total of 45 individual interviews were conducted. Interview transcripts and field notes were coded and analysed to uncover emerging themes in the data. Results Four factors related to poorly integrated transitional care were identified: confusion with communication about care, unclear roles and responsibilities, diluted personal ownership over care, and role strain due to system constraints. Conclusions Our research supports a broader notion of collaborative practice that extends beyond specific care settings and includes an appropriate, informed role for patients and informal caregivers. This research can help guide system-level and setting-specific interventions designed to promote high-quality, patient-centred care during care transitions.
Toscan, Justine; Mairs, Katie; Hinton, Stephanie; Stolee, Paul
Background Internet mailing lists are an important and increasingly common way for cancer survivors to find information and support. Most studies of these mailing lists have investigated lists dedicated to one type of cancer, most often breast cancer. Little is known about whether the lessons learned from experiences with breast cancer lists apply to other cancers. Objectives The aim of the study was to compare the structural characteristics of 10 Internet cancer-related mailing lists and identify the processes by which cancer survivors provide support. Methods We studied a systematic 9% sample of email messages sent over five months to 10 cancer mailing lists hosted by the Association of Cancer Online Resources (ACOR). Content analyses were used to compare the structural characteristics of the lists, including participation rates and members’ identities as survivors or caregivers. We used thematic analyses to examine the types of support that list members provided through their message texts. Results Content analyses showed that characteristics of list members and subscriber participation rates varied across the lists. Thematic analyses revealed very little “off topic” discussion. Feedback from listowners indicated that they actively modeled appropriate communication on their lists and worked to keep discussions civil and focused. In all lists, members offered support much more frequently than they requested it; survivors were somewhat more likely than caregivers to offer rather than to ask for support. The most common topics in survivors’ messages were about treatment information and how to communicate with health careproviders. Although expressions of emotional support were less common than informational support, they appeared in all lists. Many messages that contained narratives of illness or treatment did not specifically ask for help but provided emotional support by reassuring listmates that they were not alone in their struggles with cancer. Survivors’ explicit expressions of emotional support tended to be messages that encouraged active coping. Such messages also provided senders with opportunities to assume personally empowering “helper” roles that supported self-esteem. Conclusions Many cancer survivors use the Internet to seek informational and emotional support. Across 10 lists for different cancers, informational support was the main communication style. Our finding of an emphasis on informational support is in contrast to most prior literature, which has focused on emotional support. We found the most common expressions of support were offers of technical information and explicit advice about how to communicate with health careproviders. Topics and proportions of informational and emotional support differed across the lists. Our previous surveys of ACOR subscribers showed that they join the lists primarily to seek information; this qualitative study shows that they can and do find what they seek. They also find opportunities to play rewarding roles as support givers.
Lyons, Elizabeth J; Frydman, Gilles; Forlenza, Michael; Rimer, Barbara K
Purpose\\/Objective: 1) To identify if lesbians delay seeking health care because of sexual identity issues. 2) To examine the frequency of sexual identity disclosure for both lesbians and heterosexual women to health careprovider (HCP). 3) To identify the methods used by HCPs, lesbians, and heterosexual women to disclose sexual identity. 4) To identify lesbians' perceptions of how disclosure of
Mary Ann A. van Dam; Audrey S. Koh; Suzanne L. Dibble
This nonrandomized controlled study evaluated the effects of Family-Provider Alliance Program on nurses' perception of therapeutic alliance, job satisfaction, and quality of care. A total of 275 nurses were included in the study: 206 nurses in the ICUs participated in the Program and 69 in the control group did not. Mean postinterventional Kim Alliance Scale-Provider score was improved not only in the experimental group (+0.87; p = .01), but also in the control group (+1.37; p = .016). However, Empowerment subscale mean score was improved in the experimental group alone (+0.34; p = .006). Hierarchical multiple regression analyses indicated that family-nurse therapeutic alliance explained 7.2% and 11.4% of the variance in nurses' job satisfaction and perceived quality of care, respectively. The Program was marginally effective in improving nurses' perception of family empowerment. The quality of family-nurse therapeutic alliance predicted small to moderate fractions of the variance in nurses' job satisfaction and perceived quality of care. PMID:21460332
Kim, Son Chae; Yates, Amy D; Graham, Patricia; Brown, Caroline E
This paper considers three types of provider-client interactions that influence quantity of health care use: rationing, effort, and persuasion. By rationing, we refer to a quantity limit set by a provider; effort, the productive inputs supplied by a provider to increase a client's demand; persuasion, the unproductive inputs used by a provider to induce a client's demand. We construct a theoretical model incorporating all three mechanisms as special cases. When the general model is specialized into one of three mechanisms, a set of empirical implications emerges. We test for the presence of each mechanism using data of patients receiving outpatient treatment for alcohol abuse in the Maine Addiction Treatment System. We find evidence for rationing and persuasion, but not effort. PMID:15556245
Lien, Hsien-Ming; Albert Ma, Ching-To; McGuire, Thomas G
Fibromyalgia is a chronic widespread pain disorder commonly associated with comorbid symptoms, including fatigue and nonrestorative sleep. As in the management of other chronic medical disorders, the approach for fibromyalgia management follows core principles of comprehensive assessment, education, goal setting, multimodal treatment including pharmacological (eg, pregabalin, duloxetine, milnacipran) and nonpharmacological therapies (eg, physical activity, behavioral therapy, sleep hygiene, education), and regular education and monitoring of treatment response and progress. Based on these core management principles, this review presents a framework for primary careproviders through which they can develop a patient-centered treatment program for patients with fibromyalgia. This proactive and systematic treatment approach encourages ongoing education and patient self-management and is designed for use in the primary care setting.
Arnold, Lesley M.; Clauw, Daniel J.; Dunegan, L. Jean; Turk, Dennis C.
The purpose of these efforts, substantially supported by the Applied Research Program, is to enhance the state of the science on the quality of cancercare and inform federal and private-sector decision making on care delivery, coverage, regulation, and standard setting. Work is underway to make cancer a working model for quality of care research and the translation of this research into practice.
The "Europe Against Cancer" initiative seeks to reduce the prevalence of cancer by 15% by the year 2000. This has stimulated an increased awareness of cancer by health care professionals. A training manual was designed to provide opportunities for workplace health care professionals in Northern Ireland to make an impact in the area of prevention and early detection of cancer. The training manual examines attitudes and knowledge about cancer and discusses relevant, effective programs for the prevention and early detection of cancer. It also seeks to enable the development of care and rehabilitation support programs in the workplace. The process of developing the training manual involving occupational health and health education staff is considered to be part of its success. PMID:2069611
Approximately 200 oncologists, payers, employers, managed care executives, pharmacy benefit managers, and other healthcare stakeholders convened in Houston, TX, on March 28–31, 2012, for the Second Annual Conference of the Association for Value-Based CancerCare (AVBCC). The mission of the conference was to align the various perspectives around the growing need of defining value in cancercare and developing strategies to enhance patient outcomes. The AVBCC conference presented a forum for the various viewpoints from all the stakeholders across the cancercare continuum, featuring more than 20 sessions and symposia led by nearly 30 oncology leaders. The discussions focused on current trends and challenges in optimizing value in oncology by reducing or controlling cost while improving care quality and patient outcomes, introducing emerging approaches to management and tools that providers and payers are using to enhance cancercare collaboratively. The AVBCC Second Annual Conference was opened by a Steering Committee discussion of 11 panel members who attempted to define value in cancercare and articulated action steps that can help to implement value into cancercare delivery. The following summary represents highlights from the Steering Committee discussion, which was moderated by Gene Beed, MD, and Gary M. Owens, MD.
Beed, Gene; Owens, Gary M.; Benson, Al B.; Klein, Ira M.; Silver, Samuel M.; Beveridge, Roy A.; Malin, Jennifer; Sprandio, John D.; Deligdish, Craig K.; Mitchell, Matthew; Vogenberg, F. Randy; Fox, John; Newcomer, Lee N.
Approximately 200 oncologists, payers, employers, managed care executives, pharmacy benefit managers, and other healthcare stakeholders convened in Houston, TX, on March 28-31, 2012, for the Second Annual Conference of the Association for Value-Based CancerCare (AVBCC). The mission of the conference was to align the various perspectives around the growing need of defining value in cancercare and developing strategies to enhance patient outcomes. The AVBCC conference presented a forum for the various viewpoints from all the stakeholders across the cancercare continuum, featuring more than 20 sessions and symposia led by nearly 30 oncology leaders. The discussions focused on current trends and challenges in optimizing value in oncology by reducing or controlling cost while improving care quality and patient outcomes, introducing emerging approaches to management and tools that providers and payers are using to enhance cancercare collaboratively. The AVBCC Second Annual Conference was opened by a Steering Committee discussion of 11 panel members who attempted to define value in cancercare and articulated action steps that can help to implement value into cancercare delivery. The following summary represents highlights from the Steering Committee discussion, which was moderated by Gene Beed, MD, and Gary M. Owens, MD. PMID:24991320
Beed, Gene; Owens, Gary M; Benson, Al B; Klein, Ira M; Silver, Samuel M; Beveridge, Roy A; Malin, Jennifer; Sprandio, John D; Deligdish, Craig K; Mitchell, Matthew; Vogenberg, F Randy; Fox, John; Newcomer, Lee N
Objective: The purpose of this qualitative study was to investigate how frontline healthcare professionals witness and understand disparity in cancercare. Method: Six healthcare providers from a range of care settings, none with < 15 years of frontline experience, engaged with researchers in an iterative process of identifying and reflecting on equity and disparity in cancercare. This knowledge exchange began with formal interviews. Thematic analysis of the interviews form the basis of this article. Results: Participants drew attention to health systems issues, the meaning and experience of discontinuities in care for patients at personal and community levels, and the significance of social supports. Other concerns raised by participants were typical of the literature on healthcare disparities. Significance of results: Providers at the front lines of care offer a rich source of insight into the operation of disparities, pointing to mechanisms rarely identified in traditional quantitative studies. They are also well positioned to advocate for more equitable care at the local level. PMID:23659734
Miller, Patricia A; Sinding, Christina; McGillicuddy, Patti; Gould, Judy; Fitzpatrick-Lewis, Donna; Learn, Linda; Wiernikowski, Jennifer; Fitch, Margaret I
The utilization of medical students, residents, and fellows within the orthopaedic trauma team helps alleviate workload demands. However, many nonacademic hospitals lack these clinical resources. Therefore, orthopaedic trauma surgeons often must be creative in developing alternative methods to better manage time, staff, and patients. Incorporating midlevel providers and maximizing surgical technician assistance are favorable for both the hospital and the patient. In addition, using currently available medical devices in unique and innovative ways can help simplify patient procedures and optimize care. The purpose of this article is to detail precise tips and tricks for overcoming challenges observed during orthopaedic trauma cases when residents are unavailable. PMID:23880559
Improving the efficiency with which clinical research studies are conducted can lead to faster medication innovation and decreased time to market for new drugs. To increase this efficiency, the parties involved in a regulated clinical research study, namely, the sponsor, the clinical investigator and the regulatory body, each with their own software applications, need to exchange data seamlessly. However, currently, the clinical research and the clinical care domains are quite disconnected because each use different standards and terminology systems. In this article, we describe an initial implementation of the Semantic Framework developed within the scope of SALUS project to achieve interoperability between the clinical research and the clinical care domains. In our Semantic Framework, the core ontology developed for semantic mediation is based on the shared conceptual model of both of these domains provided by the BRIDG initiative. The core ontology is then aligned with the extracted semantic models of the existing clinical care and research standards as well as with the ontological representations of the terminology systems to create a model of meaning for enabling semantic mediation. Although SALUS is a research and development effort rather than a product, the current SALUS knowledge base contains around 4.7 million triples representing BRIDG DAM, HL7 CDA model, CDISC standards and several terminology ontologies. In order to keep the reasoning process within acceptable limits without sacrificing the quality of mediation, we took an engineering approach by developing a number of heuristic mechanisms. The results indicate that it is possible to build a robust and scalable semantic framework with a solid theoretical foundation for achieving interoperability between the clinical research and clinical care domains. PMID:23008263
In spite of national health care legislative and model program initiatives, cancer rehabilitation has not kept pace with rehabilitation for patients with other medical problems. This article discusses, from a historical perspective, unsuccessful health care legislation related to cancer and problems in establishing and expanding cancer rehabilitation programs. The attempts to establish a cancer rehabilitation program at the Texas Medical Center and the University of Texas M. D. Anderson Cancer Center are reviewed. Lessons learned over past 40 years and strategies for maintaining the success of a cancer rehabilitation program are discussed. PMID:11519034
Background While practice-level or team accreditation is not new to primary care in the UK and there are organisational indicators in the Quality and Outcomes Framework (QOF) organisational domain, there is no universal system of accreditation of the quality of organisational aspects of care in the UK. Aim To describe the development, content and piloting of version 1 of the Primary Medical CareProvider Accreditation (PMCPA) scheme, which includes 112 separate criteria across six domains: health inequalities and health promotion; provider management; premises, records, equipment, and medicines management; provider teams; learning organisation; and patient experience/involvement, and to present the results from the pilot service evaluation focusing on the achievement of the 30 core criteria and feedback from practice staff. Design of study Observational service evaluation using evidence uploaded onto an extranet system in support of 30 core summative pilot PMCPA accreditation criteria. Setting Thirty-six nationally representative practices across England, between June and December 2008. Method Study population: interviews with GPs, practice managers, nurses and other relevant staff from the participating practices were conducted, audiotaped, transcribed, and analysed using a thematic approach. For each practice, the number of core criteria that had received either a‘good’or‘satisfactory’rating from a RCGP-trained assessment team, was counted and expressed as a percentage. Results Thirty-two practices completed the scheme, with nine practices passing 100% of core criteria (range: 27–100%). There were no statistical differences in achievement between practices of different sizes and in different localities. Practice feedback highlighted seven key issues: (1) overall view of PMCPA; (2) the role of accreditation; (3) different motivations for taking part; (4) practice managers dominated the workload associated with implementing the scheme; (5) facilitators for implementation; (6) patient benefit — relevance of PMCPA to quality improvement; (7) recommendations for improving the scheme. Conclusion Version 1 of PMCPA has been piloted as a primary care accreditation scheme and shown to be relevant to different types of practice. The scheme is undergoing revision in accordance with the findings from the pilot and ongoing consultation.
Campbell, Stephen M; Chauhan, Umesh; Lester, Helen
A multilevel approach that enhances the cultural competence of clinicians and healthcare systems is suggested as one solution to reducing racial/ethnic disparities in healthcare. The primary objective of this cross-sectional study was to determine if there is a relationship between the cultural competence of primary careproviders and the clinics where they work. Forty-nine providers from 23 clinics in Baltimore, Maryland and Wilmington, Delaware, USA. completed an on-line survey which included items assessing provider and clinic cultural competence. Using simple linear regression, it was found that providers with attitudes reflecting greater cultural motivation to learn were more likely to work in clinics with a higher percent of nonwhite staff, and those offering cultural diversity training and culturally adapted patient education materials. More culturally appropriate provider behavior was associated with a higher percent of nonwhite staff in the clinic, and culturally adapted patient education materials. Enhancing provider and clinic cultural competence may be synergistic strategies for reducing healthcare disparities.
Paez, Kathryn A; Allen, Jerilyn K; Carson, Kathryn A; Cooper, Lisa A
Workers and citizens are turning increasingly to the health care system for information about occupational and environmental reproductive hazards, yet most primary careproviders and specialists know little about the effects of occupational/environmental toxicants on the reproductive system or how to evaluate and manage patients at potential risk. Although it is unrealistic to expect all clinicians to become experts in this area, practitioners should know how to take a basic screening history, identify patients at potential risk, and make appropriate referrals. At present, occupational and environmental health issues are not well integrated into health professional education in the United States, and clinical information and referral resources pertaining to reproductive hazards are inadequate. In addressing these problems, the conference "Working Group on Health Provider Education and Resources" made several recommendations that are detailed in this report. Short-term goals include enhancement of existing expertise and resources at a regional level and better integration of information on occupational/environmental reproductive hazards into curricula, meetings, and publications of medical and nursing organizations. Longer term goals include development of a comprehensive, single-access information and referral system for clinicians and integration of occupational and environmental medicine into formal health professional education curricula at all levels.
Patient-centred care is argued to be an essential component in the delivery of quality health and cancercare. This manuscript discusses the need to generate credible data which indicates the quality of patient-centred careprovided by cancer treatment centres. Patient-centred care covers six domains including physical comfort; emotional support; respect for patients' preferences and values; integration and coordination; involvement of family and friends; and the provision of information, communication and education to enable patients to understand and make informed decisions about their care. First, we identify priority areas within each domain. Next, we propose three questions that should be asked of every patient across the six domains of patient-centred care. The first question explores whether patients were specifically asked by a healthcare provider at the cancer treatment centre about their concerns, values and preferences. Research indicates that it cannot be assumed that clinicians are aware of patient's needs or preferences in these six areas. Second, if the answer from the patient suggests that they would like assistance, then it would be expected that this would be offered. Thirdly, if the patient indicates that they would like such assistance and it is provided, then it might be expected that the patient would report that the provided assistance did relieve their suffering, or the assistance provided was consistent with their preferences, needs and values. Regular measurement and reporting of these aspects of patient-centred cancercare has the potential to identify deficits and inequities in care delivery, allow for comparisons across treatment centres and stimulate an improvement in the patient-centred careprovided to cancer patients. PMID:24696084
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Background Aboriginal Australians experience poorer outcomes from cancer compared to the non-Aboriginal population. Some progress has been made in understanding Aboriginal Australians’ perspectives about cancer and their experiences with cancer services. However, little is known of cancer service providers’ (CSPs) thoughts and perceptions regarding Aboriginal patients and their experiences providing optimal cancercare to Aboriginal people. Communication between Aboriginal patients and non-Aboriginal health service providers has been identified as an impediment to good Aboriginal health outcomes. This paper reports on CSPs’ views about the factors impairing communication and offers practical strategies for promoting effective communication with Aboriginal patients in Western Australia (WA). Methods A qualitative study involving in-depth interviews with 62 Aboriginal and non-Aboriginal CSPs from across WA was conducted between March 2006 - September 2007 and April-October 2011. CSPs were asked to share their experiences with Aboriginal patients and families experiencing cancer. Thematic analysis was carried out. Our analysis was primarily underpinned by the socio-ecological model, but concepts of Whiteness and privilege, and cultural security also guided our analysis. Results CSPs’ lack of knowledge about the needs of Aboriginal people with cancer and Aboriginal patients’ limited understanding of the Western medical system were identified as the two major impediments to communication. For effective patient–provider communication, attention is needed to language, communication style, knowledge and use of medical terminology and cross-cultural differences in the concept of time. Aboriginal marginalization within mainstream society and Aboriginal people’s distrust of the health system were also key issues impacting on communication. Potential solutions to effective Aboriginal patient-provider communication included recruiting more Aboriginal staff, providing appropriate cultural training for CSPs, cancer education for Aboriginal stakeholders, continuity of care, avoiding use of medical jargon, accommodating patients’ psychosocial and logistical needs, and in-service coordination. Conclusion Individual CSPs identified challenges in cross-cultural communication and their willingness to accommodate culture-specific needs within the wider health care system including better communication with Aboriginal patients. However, participants’ comments indicated a lack of concerted effort at the system level to address Aboriginal disadvantage in cancer outcomes.
In response to a request from the Providence Ambulatory Health Care Foundation, an evaluation of the ventilation system at the Fox Point Health Care Center (SIC-8011), Providence, Rhode Island was conducted. The clinic served a population considered to ha...
Sudden infant death syndrome (SIDS) is the leading cause of death among infants aged 1 to 12 months. In this article, we review risk factors that may predispose infants to increased vulnerability. Maternal characteristics, including nonmodifiable and modifiable factors, antenatal medical conditions, labor and delivery events, and infant characteristics, are reviewed, with the purpose of helping obstetric careproviders target risk reduction efforts. We have reviewed over 85 case-control, retrospective, and prospective cohort studies published between 1975 and 2011. Major modifiable risk factors include maternal and paternal smoking, drug use, alcohol use, and insufficient prenatal care. Infants at increased risk include males, premature infants, infants of low birth weight or growth-restricted infants, and infants in multiple gestations. By targeting modifiable and nonmodifiable risk factors, it may be possible to decrease the incidence of SIDS. Efforts should be put on decreasing high-risk behaviors and encouraging sufficient antenatal follow-up. In view of recent increases in ethnic and social disparity with SIDS, it is essential that risk reduction guidelines, which have recently been expanded by the American Association of Pediatrics, be explained in a culturally sensitive manner. PMID:23292938
Pulse oximetry monitors have become so commonplace in acute health care settings over the last decade that blood oxygen is now considered a "fifth" vital sign. This study assessed the knowledge base related to pulse oximetry technology and clinical interpretation of the data given. A total of 68 participants--nurses, respiratory therapists, and resident physicians at a large general pediatric unit of a children's hospital--completed a survey of open-ended questions. Preliminary analysis revealed that 84% of the clinicians felt they received adequate training; 84% correctly identified what a pulse oximeter measured; 40% correctly identified how a pulse oximeter worked, but only 15% had a correct understanding of the oxyhemoglobin dissociation curve. Clinicians identified a wide range of normal arterial oxygen saturation values and made numerous errors in evaluating saturation readings in hypothetical clinical situations. Although the majority of pediatric staff felt well trained and knowledgeable about pulse oximetry, there was a lack of knowledge of basic principles. The results of this study have implications for basic professional education programs and the orientation and ongoing education of pediatric health careproviders. PMID:15022847
This study aimed to examine possible changes from 2008 to 2012 in the skills of health care staff in identifying and intervening in domestic violence (DV). A longitudinal descriptive study design with volunteer samples (baseline; n = 68, follow-up; n = 100) was used to acquire information regarding the present state and needs of the staff in practices related to DV. The results of the baseline survey were used as a basis for planning two interventions: staff training and drafting practical guidelines. Information was collected by questionnaires from nurses, physicians, and social workers and supplemented by responses from the interviews. The data were analysed using both quantitative and qualitative methods. A chi-square test was used to test the statistical significance of the data sets. In addition, participants' quotes are used to describe specific phenomena or issues. The comparison showed that overall a small positive change had taken place between the study periods. However, the participants were aware of their own shortcomings in identifying and intervening in DV. Changes happen slowly, and administrative support is needed to sustain such changes. Therefore, this paper offers recommendations to improve health careproviders' response to DV. Moreover, there is a great need for evaluating the training programme used. PMID:24864205
Myasthenia gravis (MG) can be difficult to treat despite an available therapeutic armamentarium. Our aim was to analyze the factors leading to unsatisfactory outcome (UO). To this end we used the Myasthenia Gravis Foundation of America classification system. Forty one patients with autoimmune MG were followed prospectively from January 2003 to December 2007. Outcomes were assessed throughout follow-up and at a final visit. 'Unchanged', 'worse', 'exacerbation' and 'died of MG' post-intervention status were considered UOs. During follow-up, UO rates reached 54% and were related to undertreatment (41%), poor treatment compliance (23%), infections (23%), and adverse drug effects (13%). The UO rate at final study assessment was 20%. UO during follow-up was significantly (P = 0.004) predictive of UOs at final assessment. When care was provided by neuromuscular (NM) specialists, patients had significantly better follow-up scores (P = 0.01). At final assessment UO rates were 7% and significantly better in patients treated by NM specialists, compared to other physicians where UO rates reached 27%. UO was a frequent finding occurring in more than half our patients during follow-up. Nearly two-thirds of the UOs could have been prevented by appropriate therapeutic adjustments and improved compliance. The differential UO rates at follow-up, their dependency on the degree to which the management was specialized and their correlation with final outcomes suggest that specialized MG care improves outcomes. PMID:19760347
This study aimed to examine possible changes from 2008 to 2012 in the skills of health care staff in identifying and intervening in domestic violence (DV). A longitudinal descriptive study design with volunteer samples (baseline; n = 68, follow-up; n = 100) was used to acquire information regarding the present state and needs of the staff in practices related to DV. The results of the baseline survey were used as a basis for planning two interventions: staff training and drafting practical guidelines. Information was collected by questionnaires from nurses, physicians, and social workers and supplemented by responses from the interviews. The data were analysed using both quantitative and qualitative methods. A chi-square test was used to test the statistical significance of the data sets. In addition, participants' quotes are used to describe specific phenomena or issues. The comparison showed that overall a small positive change had taken place between the study periods. However, the participants were aware of their own shortcomings in identifying and intervening in DV. Changes happen slowly, and administrative support is needed to sustain such changes. Therefore, this paper offers recommendations to improve health careproviders' response to DV. Moreover, there is a great need for evaluating the training programme used.
Home care nursing (HCN) improves the management of symptoms in breast and colorectal cancer patients who take the oral chemotherapy drug capecitabine, according to a study published online November 16, 2009, in the Journal of Clinical Oncology.
The rising cost of cancer treatment competes with the availability of effective therapy as a limiting factor in our war on cancer. Specific programs are being developed that have the potential to slow the growth in spending on oncology care. The Affordable Care Act includes provisions for containing healthcare costs, such as accountable care organizations and the Independent Payment Advisory Board. Within oncology, specific programs have emerged, including clinical pathways, episode-of-care based payment arrangements, and the oncology medical home. All models of cost containment have strengths and weaknesses. Outside of the United States, explicit rationing exists' through national health technology assessment organizations. Excessive demands on physicians to limit spending at the bedside could potentially create conflicts with their professional responsibility to patients. While spending for cancercare in the US is high, its "worth" is ultimately a societal decision. Recent economic modeling suggests that we may be achieving value for the money we spend. PMID:23330356
The complex environmental context must be considered as we move forward to improve cancercare and, ultimately, patient and population outcomes. The cancercare continuum represents several care types, each of which includes multiple technical and communication steps and interfaces among patients, providers, and organizations. We use two case scenarios to 1) illustrate the variability, diversity, and interaction of factors from multiple levels that affect care quality and 2) discuss research implications and provide hypothetical examples of multilevel interventions. Each scenario includes a targeted literature review to illustrate contextual influences upon care and sets the stage for theory-informed interventions. The screening case highlights access issues in older women, and the survivorship case illustrates the multiple transition challenges faced by patients, families, and organizations. Example interventions show the potential gains of implementing intervention strategies that work synergistically at multiple levels. While research examining multilevel intervention is a priority, it presents numerous study design, measurement, and analytic challenges.
Taplin, Stephen H.; Ganz, Patricia; Grunfeld, Eva; Sterba, Katherine
Assessed children's satisfaction with alternative child care. Seventy-seven children, ages three to six, from six child-care centers participated in the Child Care Game Assessment. Found that children's satisfaction regarding teacher interaction was closely related to family stress events. High maternal education levels predicted more positive…
Cancer therapy can be lifesaving but significantly diminish female reproductive potential. This review provides an overview of the deleterious effects of cancer treatments on reproductive function, the fertility preservation options currently available for young women and the outcomes of pregnancy after cancer treatment. In addition, special considerations for women who are diagnosed with cancer during pregnancy are discussed. To optimize the continuum of care for the patient, new corridors of communication between obstetricians, gynecologists and oncology specialists must be developed to ensure the best outcomes for the patient, both in terms of cancer treatment and fertility preservation.
Kong, Betty Y.; Skory, Robin M.; Woodruff, Teresa K.
Background Emergency Care Practitioners (ECPs) have recently been deployed to provide out-of-hours primary care home visits – a practice development that has been supported by policy makers. The aim of the study was to evaluate the careprovided to patients receiving out-of-hours home visits from ECPs in London from the patients' perspective and to assess their wellbeing following the visit. Methods A bespoke telephone-administered questionnaire was designed to survey all patients who had received out-of-hours care in Bromley Primary Care Trust from ECPs during a ten week period in 2005 (n = 174). Results Sixty three patients (36.2%) were excluded because: no telephone number was available; they had a diagnosis of dementia; or had not received a study information sheet. The remainder (n = 111) were contacted 3–5 days after the home visit, and 81 of these (73.0%) completed the survey. Of those respondents treated at home who gave unequivocal answers (n = 60), all but one (8.3%) reported that they felt that their treatment had been 'right' and/or had followed any advice given. However, overall only 86.4% reported that they had been clear about their ECP's assessment, and only 58.0% reported that their health was now 'better'. Those who reported that they were not clear about their assessment were less likely to report that their health was 'better' (p = 0.03) and more likely to have subsequently used hospital-based health services (p = 0.03). Conclusion Most patients treated at home by ECPs appeared satisfied and compliant with the careprovided, according to the measures used in this study. However, it appears that a sizeable minority of patients were unclear about ECP assessments and it remains to be seen whether these patients had pre-existing health complaints which made them less likely to recover and more likely to seek hospital care, or whether the lack of clarity about their assessment undermined their subsequent recovery and necessitated hospital care. Further research is required to establish if the assessments provided by ECPs are less clear than those provided by other practitioners, and whether it is possible to ensure that all such assessments are clear to all patients. Patients hold a mainly positive view of out-of-hours home visit careprovided by ECPs, although a lack of clarity about their assessment was evident, with a possible impact on their continuing health.
Halter, Mary; Marlow, Tom; Mohammed, Daryl; Ellison, George TH
Initial validation of the HIV/AIDS Provider Stigma Inventory (HAPSI), piloted on a sample of 174 nursing students, supported the psychometric qualities of a suite of measures capturing tendencies to stigmatize and discriminate against people living with HIV/AIDS (PLHA). Derived from social psychology and mindfulness theories, separate scales addressing awareness, acceptance, and action were designed to include notions of labeling, stereotyping, outgrouping, and discriminating. These were enhanced to capture differences associated with personal characteristics of PLHA that trigger secondary stigma (e.g., sexual orientation, injection drug use, multiple sex partners) and fears regarding instrumental and symbolic stigma. Reliabilities were strong (coefficients ? for 16 of 19 resulting measures ranged from 0.80 to 0.98) and confirmatory factor analyses indicated good model fit for two multidimensional (Awareness and Acceptance) and one unidimensional (Action) measure. Evidence of convergent construct validity supported accuracy of primary constructs. Implications for training and professional socialization in health care are discussed. PMID:21967495
Rutledge, Scott Edward; Whyte, James; Abell, Neil; Brown, Kristin M; Cesnales, Nicole I
Healthcare providers serving rural populations face numerous barriers to accessing educational programming. Difficulties accessing continuing professional education contribute to the challenges of providing comprehensive health care in the rural setting. Telehealth can inform and educate rural providers about changes in medicine and evidence-based practices, both of which may help them provide quality care. The Native People for Cancer Control Telehealth Network used telehealth technology to deliver a cancer education series in 2008 and 2009 to Washington and Alaska rural healthcare providers who treated American Indians and Alaska Native people. Customizing presentation content to providers' educational needs encouraged attendance. Evaluation indicated videoconferencing technology was positively received for delivery of the educational sessions. This series demonstrated videoconferencing was a satisfactory means of delivering real-time, interactive cancer educational programming to providers who might not otherwise have access to such programs. PMID:21336979
Millions of uninsured people use health care services every year. We estimated providers' uncompensated care costs in 2013 to be between $74.9 billion and $84.9 billion. We calculated that in the aggregate, at least 65 percent of providers' uncompensated care costs were offset by government payments designed to cover the costs. Medicaid and Medicare were the largest sources of such government payments, providing $13.5 billion and $8.0 billion, respectively. Anticipating fewer uninsured people and lower levels of uncompensated care, the Affordable Care Act reduces certain Medicare and Medicaid payments. Such cuts in government funding of uncompensated care could pose challenges to some providers, particularly in states that have not adopted the Medicaid expansion or where implementation of health care reform is proceeding slowly. PMID:24799578
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While the discipline of psychosocial oncology is rela- tively new in the field of cancercare, many if not most health careproviders, would say that it is a vital compo- nent of clinical care and its application is necessary to improve the patient experience along the cancercare continuum from diagnosis, treatment, recurrent dis- ease, palliative care and survivorship.
... Cancer Treatment Online Communities and Support To help primary care doctors and prostate cancer survivors better manage prostate ... of side effects, and coordination of care among primary care doctors and specialists. “We are hopeful that the ...
Summary Pancreatic cancer is one of the most lethal malignancies. An estimated 32,300 patients will die of pancreatic cancer in year 2006. It is the tenth most common malignancy in the United State. Despite recent advances in pathology, molecular basis and treatment, the overall survival rate remains 4% for all stages and races. Palliative care represents an important aspect of
African Americans are disproportionately burdened with colorectal cancer. Although incidence and mortality rates have declined in the past two decades, the disparity in health outcomes has progressively increased. This comprehensive review examines the existing literature regarding racial disparities in colorectal cancer screening, stage at diagnosis, and treatment to determine if differences exist in the quality of care delivered to African
Jamillah Berry; Kevin Bumpers; Vickie Ogunlade; Roni Glover; Sharon Davis; Margaret Counts-Spriggs; John Kauh; Christopher Flowers
Expert-reviewed information summary about communicating with the cancer patient and his or her family, including unique aspects of communication with cancer patients, factors affecting communication, and training in communication skills.
This review focuses on the aspects of biopsychosocial screening that have specific and significant implications for supportive care related to cancercare and research. There is a robust literature relating to the unmet supportive care needs of cancer patients and their families and the clinical interventions needed to effectively manage many of their problems. The Zeitgeist movement, which promotes the idea that the resources of this planet are the inherent right of all peoples, is also uniquely aligned to see supportive care services in oncology bringing significant value (cost and quality) to a health care system that is experiencing great uncertainty. Overall, there is a broadening of perspective within the supportive care community that there needs to be greater levels of interdisciplinary integration. More significantly, there is a growing realization that for cancercare to be truly patient and family centered and even minimally efficient, disease-directed care and supportive care need to be integrated from the time of diagnosis. The coordination of these services should not be based on the stage of the disease but rather tailored to the needs of the patient, family, and social context. Biopsychosocial screening programs have the potential to be the connective tissue of these patient- and family-centered systems. PMID:24051615
Loscalzo, Matthew; Clark, Karen; Pal, Sumanta; Pirl, William F
Many of the estimated thirty-two million Americans expected to gain coverage under the Affordable Care Act are likely to have high levels of unmet need because of various chronic illnesses and to live in areas that are already underserved. In New Mexico an innovative new model of health care education and delivery known as Project ECHO (Extension for Community Healthcare Outcomes) provides high-quality primary and specialty care to a comparable population. Using state-of-the-art telehealth technology and case-based learning, Project ECHO enables specialists at the University of New Mexico Health Sciences Center to partner with primary care clinicians in underserved areas to deliver complex specialty care to patients with hepatitis C, asthma, diabetes, HIV/AIDS, pediatric obesity, chronic pain, substance use disorders, rheumatoid arthritis, cardiovascular conditions, and mental illness. As of March 2011, 298 Project ECHO teams across New Mexico have collaborated on more than 10,000 specialty care consultations for hepatitis C and other chronic diseases. PMID:21596757
Compelling public interest is propelling national efforts to advance the evidence base for cancer treatment and control measures and to transform the way in which evidence is aggregated and applied. Substantial investments in health information technology, comparative effectiveness research, health care quality and value, and personalized medicine support these efforts and have resulted in considerable progress to date. An emerging initiative, and one that integrates these converging approaches to improving health care, is “rapid-learning health care.” In this framework, routinely collected real-time clinical data drive the process of scientific discovery, which becomes a natural outgrowth of patient care. To better understand the state of the rapid-learning health care model and its potential implications for oncology, the National Cancer Policy Forum of the Institute of Medicine held a workshop entitled “A Foundation for Evidence-Driven Practice: A Rapid-Learning System for CancerCare” in October 2009. Participants examined the elements of a rapid-learning system for cancer, including registries and databases, emerging information technology, patient-centered and -driven clinical decision support, patient engagement, culture change, clinical practice guidelines, point-of-care needs in clinical oncology, and federal policy issues and implications. This Special Article reviews the activities of the workshop and sets the stage to move from vision to action.
Abernethy, Amy P.; Etheredge, Lynn M.; Ganz, Patricia A.; Wallace, Paul; German, Robert R.; Neti, Chalapathy; Bach, Peter B.; Murphy, Sharon B.
Individuals at high risk for hereditary cancers often receive genetic counseling and testing at tertiary care centers; however, they may receive care for long-term management of their cancer risk in community settings. Communication of genetic test results to health careproviders outside of tertiary care settings can facilitate the long-term management of high risk individuals. This study assessed women's communication of BRCA1/BRCA2 genetic test results to health careproviders outside of tertiary care settings (termed "outside" health careproviders, or OHCPs) and women's perceptions regarding communication of results. Women (n = 312) who underwent BRCA1/BRCA2 genetic counseling and testing completed a questionnaire assessing whether or not they shared test results with OHCPs and perceptions regarding the communication of test results to OHCPs. Most (72%) shared genetic test results with OHCPs. Women with no personal history of cancer were more likely to have shared results compared to women with a personal history of cancer. Mutation status did not significantly predict sharing of genetic information. Most reported positive perceptions regarding the disclosure of genetic test results to OHCPs. The majority did not report any concerns about potential insurance discrimination (88%) and indicated that OHCPs were able to appropriately address their questions (81%). Although most women shared their genetic test results with OHCPs, those with a personal history of cancer may need further encouragement to share this information. Tertiary care centers should facilitate outreach and education with OHCPs in order to assure appropriate long-term cancer risk management for high risk populations. PMID:21681553
Ready, K; Arun, B K; Schmeler, K M; Uyei, A; Litton, J K; Lu, K H; Sun, C C; Peterson, S K
After birth, newborns and their caregivers are seen routinely and frequently in pediatric primary care settings. The close succession of visits in the first few months of life puts pediatric primary care professionals in a unique position to enhance infant mental health by developing strong relationships with caregivers, supporting babies and…
Care drain brings the traditional problem of carers’ choice between paid work and family at a new level. Taking care drain from Romania as a case study, I analyse the consequences of parents’ migration within a normative framework committed to meeting the needs of vulnerable individuals. The temporary migration of parents who cannot take their children with them involves moral
The President's Cancer Panel (PCP) has begun a series of regional meetings over the next nine months to hear testimony from all 50 states addressing the question, "Why don't all Americans get the best available care"?
Background While it is recommended that records are kept between primary careproviders (PCPs) and specialists during patient transitions from hospital to community care, this communication is not currently standardized. We aimed to assess the transmission of cardiac rehabilitation (CR) program intake transition records to PCPs and to explore PCPs' needs in communication with CR programs and for intake transition record content. Method 144 PCPs of consenting enrollees from 8 regional and urban Ontario CR programs participated in this cross-sectional study. Intake transition records were tracked from the CR program to the PCP's office. Sixty-six PCPs participated in structured telephone interviews. Results Sixty-eight (47.6%) PCPs received a CR intake transition record. Fifty-eight (87.9%) PCPs desired intake transition records, with most wanting it transmitted via fax (n = 52, 78.8%). On a 5-point Likert scale, PCPs strongly agreed that the CR transition record met their needs for providing patient care (4.32 ± 0.61), with 48 (76.2%) reporting that it improved their management of patients' cardiac risk. PCPs rated the following elements as most important to include in an intake transition record: clinical status (4.67 ± 0.64), exercise test results (4.61 ± 0.52), and the proposed patient care plan (4.59 ± 0.71). Conclusions Less than half of intake transition records are reaching PCPs, revealing a large gap in continuity of patient care. PCP responses should be used to develop an evidence-based intake transition record, and procedures should be implemented to ensure high-quality transitional care.
Objectives: Cancer genetics clinics have been established in many major oncology centers worldwide in recent years. For such specialized clinics to fulfill their function, primary care physicians need to identify high-risk patients for referral. Methods: We conducted a survey to evaluate the level of awareness of breast cancer risk factors and hereditary breast cancer among health careproviders and patients.
This article examines the extent of derivative financial instrument use among US nonprofit health systems and the impact of these financial instruments on their cash flows, reported operating results, and financial risks. Our examination is conducted through a case study of New Jersey hospitals and health systems. We review the existing literature on interest rate derivative instruments and US hospitals and health systems. This literature describes the design of these derivative financial instruments and the theoretical benefits of their use by large health careprovider organizations. Our contribution to the literature is to provide an empirical evaluation of derivative financial instruments usage among a geographically limited sample of US nonprofit health systems. We reviewed the audited financial statements of the 49 community hospitals and multi-hospital health systems operating in the state of New Jersey. We found that 8 percent of New Jersey's nonprofit health providers utilized interest rate derivatives with an aggregate principle value of $229 million. These derivative users combine interest rate swaps and caps to lower the effective interest costs of their long-term debt while limiting their exposure to future interest rate increases. In addition, while derivative assets and liabilities have an immaterial balance sheet impact, derivative related gains and losses are a material component of their reported operating results. We also found that derivative usage among these four health systems was responsible for generating positive cash flows in the range of 1 percent to 2 percent of their total 2001 cash flows from operations. As a result of our admittedly limited samples we conclude that interest rate swaps and caps are effective risk management tools. However, we also found that while these derivative financial instruments are useful hedges against the risks of issuing long-term financing instruments, they also expose derivative users to credit, contract termination and interest rate volatility risks. In conclusion, we find that these financial instruments can also generate negative as well as positive cash flows and have both a positive and negative impact on reported operating results. PMID:15839528
... hospitals in the health care system in 2010. Keywords: National Hospital Discharge Survey, inpatient hospital utilization What ... but according to the U.S. Agriculture Department’s Economic Research Service ( 14 ), metropolitan status is used to determine ...
Examines the problems technical innovation has brought to health care professionals, administrators, and patients from the standpoints of increased specialization, equipment obsolescence, bureaucracy, retraining, regulations, high costs of services, depersonalization, and ethical dilemmas. (CT)
Palliative care improves the quality of life of patients and their families facing problems associated with life-threatening illnesses by promoting the prevention and relief of suffering. Palliative care in Japan has been developed mainly for cancer patients. At the National Center for Geriatrics and Gerontology, an end-of-life care team (EOLCT) has been developed to promote palliative care for patients without cancer. In the first 6 months of its operation, 109 requests were received by the team, 40% of which were for patients without cancer or related disease, including dementia, frailty due to advanced age, chronic respiratory failure, chronic heart failure, and intractable neurologic diseases. The main purpose of the EOLCT is to alleviate suffering. The relevant activities of the team include the use of opioids, providing family care, and giving support in decision-making (advance care planning) regarding withholding; enforcement; and withdrawal of mechanical ventilators, gastric feeding tubes, and artificial alimentation. The EOLCT is also involved in ongoing discussions of ethical problems. The team is actively engaged in the activities of the Japanese Geriatric Society and contributes to the development of decision-making guidelines for end-of-life by the Ministry of Health, Labour and Welfare. The EOLCT can be helpful in promoting palliative care for patients with diseases other than cancer. The team offers support during times of difficulty and decision-making. PMID:24047661
Background Despite attempts from the government to improve ante- and perinatal care, Afghanistan has once again been labeled “the worst country in which to be a mom” in Save the Children’s World’s Mothers’ Report. This study investigated how pregnant women and health careproviders experience the existing antenatal and obstetric health care situation in Afghanistan. Methods Data were obtained through one-to-one semi-structured interviews of 27 individuals, including 12 women who were pregnant or had recently given birth, seven doctors, five midwives, and three traditional birth attendants. The interviews were carried out in Kabul and the village of Ramak in Ghazni Province. Interviews were taped, transcribed, and analyzed according to the principles of Giorgi’s phenomenological analysis. Results Antenatal care was reported to be underused, even when available. Several obstacles were identified, including a lack of knowledge regarding the importance of antenatal care among the women and their families, financial difficulties, and transportation problems. The women also reported significant dissatisfaction with the attitudes and behavior of health personnel, which included instances of verbal and physical abuse. According to the health professionals, poor working conditions, low salaries, and high stress levels contributed to this matter. Personal contacts inside the hospital were considered necessary for receiving high quality care, and bribery was customary. Despite these serious concerns, the women expressed gratitude for having even limited access to health care, especially treatment provided by a female doctor. Health professionals were proud of their work and enjoyed the opportunity to help their community. Conclusion This study identified several obstacles which must be addressed to improve reproductive health in Afghanistan. There was limited understanding of the importance of antenatal care and a lack of family support. Financial and transportation problems led to underuse of available care, especially by poorly educated rural women. Patients frequently complained of being treated disrespectfully, and health careproviders correspondingly complained about poor working conditions leading to exhaustion and a lack of compassion. Widespread corruption, including the necessity of personal contacts inside hospitals, was also emphasized as an obstacle to equitable antenatal and obstetric health care.
Trust in health careproviders and the health care system are essential. This study examined factors associated with trust in providers and distrust in the health care system among minority HIV-positive and -negative women.Interviews were conducted and laboratory tests performed with 102 women from the Women's Interagency HIV Study Bronx site. Interviews collected information about trust in providers, distrust in
C. O. Cunningham; N. L. Sohler; L. Korin; W. Gao; K. Anastos
The medical care of end-stage renal disease (ESRD) patients includes not only dialysis-related medical care but preventive and general medical care as well as the care of minor acute illnesses. There is little information about nephrologists' interpretation of their potential role as a primary health careprovider for the general medical needs of chronic dialysis patients. To characterize nephrologists' primary
The National Cancer Institute (NCI) Division of Cancer Control and Population Sciences is pleased to announce the May 2012 Journal of the National Cancer Institute (JNCI) Special Issue, Understanding and Influencing Multilevel Factors Across the CancerCare Continuum.
Although the prevalence of cigarette smoking has declined in the United States, little documentation exists to ascertain which health careproviders (HCPs) promote smoking cessation. We used data from the 2000, 2005, and 2010 Cancer Control Supplement of the National Health Interview Survey to examine changes in the number of adults who received smoking cessation advice from their HCP. The percentage of smokers who received cessation advice was 53.3% in 2000, 58.9% in 2005, and 50.7% in 2010. To affect noticeably declining rates, HCPs should increase their efforts to advise smokers to quit. PMID:22814236
... important to patients coping with cancer. Spirituality and religion may have different meanings. Serious illness, such as ... information on end-of-life issues.) Spirituality and religion may have different meanings. The terms spirituality and ...
Purpose Because insurers use performance and quality metrics to inform reimbursement, identifying remediable causes of poor-quality cancercare is imperative. We undertook this descriptive cohort study to assess key predictors of women's perceived quality of their breast cancercare and actual guideline-concordant quality of care received. Patients and Methods We surveyed inner-city women with newly diagnosed and surgically treated early-stage breast cancer requiring adjuvant treatment who were enrolled onto a randomized controlled trial (RCT) of patient assistance to reduce disparities in care. We assessed women's perceived quality of care and perceived quality of the process of getting care, such as getting referrals, test results, and treatments; we abstracted records to determine the actual quality of care. Results Of the 374 new patients with early-stage breast cancer enrolled onto the RCT, only a slight majority of women (55%) perceived their quality of care as excellent; 88% actually received good-quality, guideline-concordant care. Excellent perceived quality (P < .001) was significantly associated with patients' perception of the quality of the process of getting care (adjusted relative risk [RR], 1.78; 95% CI, 1.65 to 1.87). Also associated with perceived quality—and mediated by race—were trust in one's physician (adjusted RR, 1.43; 95% CI, 1.16 to 1.64) and perceived racism, which affected black women more than women of other races/ethnicities (black race–adjusted RR for perceived racism, 0.33 [95% CI, 0.10 to 0.87]; black race–adjusted RR for trust, 1.61 [95% CI, 0.97 to 1.90]; c = 0.82 for the model; P < .001). Actual quality of careprovided did not affect perceived quality of care received. Conclusion Patients' perceived quality of care differs from their receipt of high-quality care. Mutable targets to improve perceived quality of care include the processes of getting care and trusting their physician.
This list of clinical trials is not intended to be all-inclusive. Rather it is intended to provide you with most of the trials considered CancerCare Delivery Research (CCDR) in the NCI CCOP program over approximately the last 6 years.
This report analyzes the following 10 curricula for training programs for family child careproviders: (1) Child Care, a family day home careprovider program developed by Texas A&M's Agricultural Extension Service; (2) the Family Day Care Education Series, a coordinated resource manual and independent study course, the Active Learning Series, and…
Patient-centered cancercare has become a priority in the oncology field. Increasing efforts to train oncologists in communication skills have led to a growing literature on patient-centered cancer education. In addition, systems approaches have led to an increased emphasis on the concept of teams as an organizing framework for cancercare. In this essay, we examine issues involved in educating teams to provide patient-centered cancercare. In the process, we question the applicability of a tightly coordinated ‘team’ concept, and suggest the concept of a ‘care community’ as a more achievable ideal for the way that cancercare is commonly delivered. We discuss the implications that this has for cancer communication education, and propose three principles to guide the development of educational interventions aimed at increasing patient-centeredness in cancercare delivery systems.
Haidet, Paul; Fecile, Mary Lynn; West, Heather F.; Teal, Cayla R.
We report on the nature and timing of services provided to children with an intellectual disability (ID) identified by a new comprehensive assessment and care planning tool used to evaluate children's needs for Medicaid Personal Care Services (PCS) in Texas. The new assessment procedure resulted from a legal settlement with the advocacy…
Elliot, Timothy R.; Patnaik, Ashweeta; Naiser, Emily; Fournier, Constance J.; McMaughan, Darcy K.; Dyer, James A.; Phillips, Charles D.
Previvors are individuals who are survivors of a genetic predisposition for developing cancer. They often are confronted with difficult decisions about management of risks that might include aggressive screening and prophylactic surgery. Psychosocial challenges exist for the affected individual, their partners, and offspring. Oncology nurses need to be aware of the complex and special needs of this ever-growing population. PMID:24476722
Worldwide, hepatocellular carcinoma (HCC) is the third leading cause of cancer deaths and the ninth in the US. Hepatitis B and C make up almost 80 % of HCC cases. Based on our Hepatitis Outreach Network screening program data, approximately 40 % of at-risk foreign-born community members who tested positive for viral hepatitis B and/or C did not follow up for additional care. Our aim was to use theory-driven qualitative research to identify barriers and facilitators to follow-up after viral hepatitis diagnosis among these community members from the viewpoint of primary careproviders (PCPs). As viral hepatitis is a precursor of liver cancer, timely treatment of the virus has the potential to reduce the incidence and burden of liver cancer. We performed semi-structured key informant interviews with 20 primary care physicians who predominantly serve Korean, Chinese, Egyptian, and Russian communities. Barriers detected included cultural factors commonly seen amongst immigrant populations such as busy work schedules and non-English language. Common facilitators include increased primary care physician involvement and linkages to care within communities in which patients reside. Providers perceived that they are gatekeepers to specialty care for their patients and therefore key persons to engage in viral hepatitis evaluation and management by specialists. This initial study suggests that re-focusing energy into primary care physicians might offer promise for improved care for individuals from immigrant communities who have viral hepatitis to help them engage in care and thereby reduce the burden of liver cancer. PMID:24189830
Han, Hyosun; Perumalswami, Ponni V; Kleinman, Lawrence C; Jandorf, Lina H
The guide offers information to family day careproviders who desire to expand their knowledge of early childhood development in order to work with infants and young children with special needs in their day care settings. The first of four chapters answers common questions and concerns of day careproviders, describes children with special needs…
This study examines family child careproviders' perspectives regarding effective professional development and their role in the early learning and care system. Four focus groups were conducted annually for 3 years involving a total of 54 licensed family child careproviders. Supportive social relationships emerged as an important dimension of…
In recent approaches to ethics, the personal involvement of health careproviders and their empathy are perceived as important elements of an overall ethical ability. Experiential working methods are used in ethics education to foster, inter alia, empathy. In 2008, the care-ethics lab 'sTimul' was founded in Flanders, Belgium, to provide training that focuses on improving careproviders' ethical abilities through experiential working simulations. The curriculum of sTimul focuses on empathy sessions, aimed at careproviders' empathic skills. The present study provides better insight into how experiential learning specifically targets the empathic abilities of careproviders. Providing contrasting experiences that affect the careproviders' self-reflection seems a crucial element in this study. Further research is needed to provide more insight into how empathy leads to long-term changes in behaviour. PMID:22140188
Vanlaere, Linus; Timmermann, Madeleine; Stevens, Marleen; Gastmans, Chris
Poor communication and collaboration between members of a patient's health care team can result in medical errors and poor quality of care. The purpose of this study was to assess communication and consensus regarding patient care goals between members of...
B. Evanoff P. Potter L. Wolf D. Grayson C. Dunagan
Derek Middleton, regional director, and Steve Gunning, director, at multi-disciplinary planning, design and engineering consultancy Faber Maunsell, look back on a complex, yet rewarding, project to deliver Europe's largest state-of-the-art cancer treatment facility, highlighting some of the challenges the project team faced in bringing the scheme in on time and budget. PMID:18988617
Objectives: Unmarried women are less likely than married women to receive recommended cancer screenings. Patient-provider communication is a consistent predictor of cancer screening among women. The purpose of this study was to investigate the relationship between patient-provider communication, barriers to cancer screening, and on-schedule breast and cervical cancer screening (BCCS) among unmarried women. Methods: Data were from the Cancer Screening Project for Women, a 2003-2005 survey examining cancer screening practices. We computed polytomous logistic regression models to examine the relationship between communication (communication about tests, communication about sexual and intimate relationships), barriers to screening, and on-schedule BCCS among unmarried women. Results: A total of 630 women were enrolled, and 605 women completed the baseline questionnaire. Overall, more than 60% reported on-schedule BCCS. More than half reported that their providers communicated about BCCS most or all of the time. Fewer than half communicated about sexual history and intimate relationships. Women who reported that their providers communicated about screening tests and their sexual and intimate relationships were more likely to be on-schedule for BCCS. Conclusion: Patient-provider communication in multiple areas may encourage women to remain on-schedule for their recommended cancer screenings. Longitudinal research should be conducted to examine whether communication predicts BCCS, and to examine how patient and provider characteristics may influence communication in order to promote adherence to screening guidelines for unmarried women. Practice Implications: Comprehensive communication that goes beyond information about screening tests may impact adherence to cancer screening guidelines.
Politi, Mary C.; Clark, Melissa A.; Rogers, Michelle L.; McGarry, Kelly; Sciamanna, Chris N.
Supportive care of cancer patients starts from the first day of diagnosis. It is a comprehensive approach involving psychosocial, physical and spiritual supports. Maximum efforts are put in to keep the patients as comfortable as possible during diagnosis, during treatment and during the terminal stages of their disease. PMID:9176964
Shetty, P; Rizk, K; Sadek, H; Abbas, M; Hamza, A; John, A
Purpose – The purpose of this paper is to show that performance data use could be promoted with a better understanding of the type of indicators that are important to different stakeholders. This study explored patient, nurse, physician and manager preferences for cancercare quality indicators. Design\\/methodology\\/approach – Interviews were held with 30 stakeholders between March and June 2004. They
Anna Gagliardi; Louise Lemieux-Charles; Adalsteinn Brown; Terry Sullivan; Vivek Goel
We examined the features of home care for patients with noncurable breast cancer. The patients were 21 women with advanced breast cancer who entered the home care program between April 1987 and May 2001. The first feature was that their young age: six of them were in their forties, five were in their fifties, and the mean age was 57.4 years old. The second feature was that the period home care was provided was long. The mean duration of home care from the beginning to their death was 143 days. This was because the period of sickness and the period until the breast cancer's relapsing were both long. The mean period until the relapse was 2.3 years, and the mean period of sickness was 4.1 years. The third feature was the great variety of symptoms. It is this cause that there are a lot of metastasis organs. The fourth feature was that no special treatment, such as infusion therapy, was really necessary to alleviate the symptoms. Pain control was important because there were a lot of patients whose main complaint was pain. However, pain could be controlled with morphine. In conclusion, if it is excluded not to have the nursing power because the age is generally young, home care can be comparatively offered to the person who has an advanced breast cancer for a long term. PMID:11787277
Objective: To characterize standard clinical care for antiretroviral therapy (ART) adherence and retention in HIV-care support strategies among careproviders attending the 2010 5th International Conference on HIV Treatment Adherence. Methods: A brief survey was included in conference packets, covering adherence monitoring and support strategies and retention in care strategies used in standard clinical care. Results: A total of 51
Objective and Participants: The authors examined the experiences of primary careproviders participating in an integrated healthcare service between mental health and primary care in a university health center. In this program, behavioral health providers work collaboratively with primary careproviders in the treatment of students. Participants…
Westheimer, Joshua M.; Steinley-Bumgarner, Michelle; Brownson, Chris
Purpose: Patient satisfaction with the provision of hospital oncology services can have a significant impact on their overall treatment experience. Aims: To assess patient satisfaction with the inpatient hospital services in the gynecological oncology setting using the IN-PATSAT32 questionnaire developed by the European Organization for Research and Treatment of Cancer (EORTC). Methods: A modified version of the IN-PATSAT32 questionnaire with additional 16 items was administered to 52 adult surgical inpatients admitted with the Sydney Gynecological Oncology Group. All participants were provided with an information leaflet regarding the survey and written consent obtained. Results: A high response rate (100%) from patients with varied social, ethnic, and educational backgrounds confirmed the acceptability of the survey. Standard of medical careprovided, frequency of doctors’ visits, exchange of information with doctors, friendliness of the staff, and state of the room ranked highly (>95%) on the patient satisfaction scales. Problems were identified with ease of access to and within the hospital, quality of food, and exchange of information with other hospital staff. Conclusions: Overall the satisfaction with inpatient care was rated very highly in most areas. Deficiencies in certain elements of provision of medical care to the patients were identified and steps have been taken to improve upon these shortcomings.
There is a compelling need to integrate spirituality into the provision of quality palliative care by oncology professionals. Patients and families report the importance of spiritual, existential, and religious concerns throughout the cancer trajectory. Leading palliative care organizations have developed guidelines that define spiritual care and offer recommendations to guide the delivery of spiritual services. There is growing recognition that all team members require the skills to provide generalist spiritual support. Attention to person-centered, family-focused oncology care requires the development of a health care environment that is prepared to support the religious, spiritual, and cultural practices preferred by patients and their families. These existential concerns become especially critical at end of life and following the death for family survivors. Oncology professionals require education to prepare them to appropriately screen, assess, refer, and/or intervene for spiritual distress. PMID:24051617
For many health conditions, the process or result of medical procedures improves with increasing caseload. The evidence about breast cancer has not been thoroughly assessed. This review synthesizes the literature about provider's volume and performance in either breast cancer screening with mammography or treatment. Articles published in English between 1990 and 2006 were identified by a computerized search and by review of reference lists. In screening with mammography, the reading volume of the radiologist and the screening volume of the facility influence different components of performance. The most conclusive evidence for breast cancer treatment concerns the association between the surgeon's caseload and the process or end-results of therapeutic interventions. Although the mechanisms of these associations still need to be clarified, large provider's volume in screening mammography or breast cancer treatment is often related to the quality of medical interventions. PMID:17186361
Hébert-Croteau, Nicole; Roberge, Danièle; Brisson, Jacques
Objective To explore views of service providerscaring for injured people on: the extent to which services meet patients’ needs and their perspectives on factors contributing to any identified gaps in service provision. Design Qualitative study nested within a quantitative multicentre longitudinal study assessing longer term impact of unintentional injuries in working age adults. Sampling frame for service providers was based on patient-reported service use in the quantitative study, patient interviews and advice of previously injured lay research advisers. Service providers’ views were elicited through semistructured interviews. Data were analysed using thematic analysis. Setting Participants were recruited from a range of settings and services in acute hospital trusts in four study centres (Bristol, Leicester, Nottingham and Surrey) and surrounding areas. Participants 40 service providers from a range of disciplines. Results Service providers described two distinct models of trauma care: an ‘ideal’ model, informed by professional knowledge of the impact of injury and awareness of best models of care, and a ‘real’ model based on the realities of National Health Service (NHS) practice. Participants’ ‘ideal’ model was consistent with standards of high-quality effective trauma care and while there were examples of services meeting the ideal model, ‘real’ care could also be fragmented and inequitable with major gaps in provision. Service provider accounts provide evidence of comprehensive understanding of patients’ needs, awareness of best practice, compassion and research but reveal significant organisational and resource barriers limiting implementation of knowledge in practice. Conclusions Service providers envisage an ‘ideal’ model of trauma care which is timely, equitable, effective and holistic, but this can differ from the care currently provided. Their experiences provide many suggestions for service improvements to bridge the gap between ‘real’ and ‘ideal’ care. Using service provider views to inform service design and delivery could enhance the quality, patient experience and outcomes of care.
Caring for Quality and Partners in Family Child Care are home visiting programs designed to improve the quality of home-based child care. This article describes the experiences of two different home visitors to demonstrate how programs such as these can help providers improve the overall quality of care, increase children's development, and lead…
McCabe, Lisa A.; Peterson, Shira M.; Baker, Amy C.; Dumka, Marsha; Brach, Mary Jo; Webb, Diana
Jersey Hospice Care, established in 1982, provides a care and support service for the community. The service includes provision of palliative care, focusing on pain assessment and control. Mainly a home-care service, it is supported by a day hospice, lymphoedema service, the provision of complementary therapies, a six-bed in-patient unit and a bereavement service. PMID:12030064
... Oncology , surveyed 1,130 oncologists and 1,020 primary care doctors about their discussions with survivors about handling ... care. The National Cancer Institute study showed that primary care doctors who received a written plan from the ...
The issue of quality of care involves many different components, including what cancercare quality looks like, which patients are more likely to receive poor quality care, and ways to measure healthcare quality.
Existing scales to measure trust in physicians have differing content and limited testing. To improve on these measures, a detailed conceptual model was constructed and a large item pool (n = 78) was generated following a detailed conceptual model and expert review. After pilot testing, the best-performing items were validated with a random national sample (n = 959) and a regional sample of HMO members (n =1,199). Various psychometric tests produced a 10-item unidimensional scale consistent with most aspects of the conceptual model. Compared with previous scales, the Wake Forest physician trust scale has a somewhat improved combination of internal consistency, variability, and discriminability. The scale is more strongly correlated with satisfaction, desire to remain with a physician, willingness to recommend to friends, and not seeking second opinions; it is less correlated with insurer trust, membership in managed care, and choice of physician. Correlations are equivalent with lack of disputes, length of relationship, and number of visits [corrected]. PMID:12205830
Primary care has changed remarkably with chronic disease burden growth. Nurse case managers assist with this chronic disease by providing if not significantly better care, than equivalent care to that provided by usual primary careproviders. Chronic disease management requires patient-centered skills and tools, such as registries, panel management, review of home data, communicating with patients outside of face-to-face care, and coordinating multiple services. Evidence reviewed in this article demonstrates that registered nurse care managers (RNCM) perform many actions required for diabetes chronic disease management including initiation and titration of medications with similar or improved physiologic and patient satisfaction outcomes over usual careproviders. Selection and training of the nurse case managers is of utmost importance for implementation of a successful chronic disease management program. Evidence based guidelines, algorithms, protocols, and adequate ongoing education and mentoring are generally cited as necessary support tools for the nurse case managers. PMID:24816751
This study analyzed the content of sun-care product advertisements in five major U.S. parenting magazines with high circulation: Family Circle, Parents, Family Fun, Parenting (Early Years), and Parenting (School Years). The study examined what information sun-care product advertisements tell parents about skin cancer prevention and about sunscreen use for themselves or for their children based on the Health Belief Model concepts of perceived benefits and perceived barriers. Results showed that the most commonly mentioned benefit of the product was that it blocks ultraviolet A (UVA) and ultraviolet B (UVB) rays. One-third of the ads promoted the product's effectiveness in overcoming four of the barriers that prevent people from using sunscreens: eye irritation, skin irritation, an unpleasant smell, and the need to reapply sunscreen too often or after physical activity. However, only a few of the ads provided information about the consequences of unprotected sun exposure or mentioned methods of sun protection or skin cancer prevention other than sunscreen use. We discuss the implications of these messages for parents' ability to understand correctly how to protect their children from damaging sun exposure. PMID:23066971
Purpose: Cancer treatment can be a complex and confusing process for both the patients and the careproviders. With an ever-increasing array of treatment options, a push toward personalized medicine, and a complex payer system, coordination of cancercare is essential in streamlining the process. At Intermountain Healthcare, we have developed a hospital-based multidisciplinary cancer clinic that provides coordinated and comprehensive treatment planning in a single visit. Provider participation is open to employed, affiliated, and community physicians. Methods: The first multidisciplinary clinic, which was for breast cancer, was held in 2005. Similar clinics for other tumor types have subsequently been instituted, including clinics for genitourinary/prostate, GI/liver/pancreas, sarcoma, and thoracic cancer. Each clinic is staffed by a surgeon, medical oncologist, radiation oncologist, and other specialists as needed. Clinic meetings are held immediately following a specialty tumor conference during which each patient is discussed. The patients then meet one-on-one with each specialist and leave the clinic with an individualized treatment plan. Patient and physician satisfaction surveys are regularly conducted. Financial metrics are calculated to track downstream revenue. Results: Satisfaction with the clinic has been high, and 98% of patients rated their overall experience as “excellent.” Physicians also give the clinic high marks, crediting it with improving communication, building patient confidence, and increasing efficiency. Conclusion: The multidisciplinary clinic at Intermountain Healthcare has greatly improved the cancercare process for patients, physicians, and the community. If implemented appropriately, multidisciplinary clinics have the potential to enhance quality of care and increase downstream revenue.
Policymakers are increasingly designing policies that encourage patient choice and therefore mobility across providers. Since prices are regulated (fixed) in most countries, providers need to compete on quality to attract patients. This chapter reviews the current theoretical and empirical literature on patient choice and quality competition in health markets. The theoretical literature identifies key factors affecting incentives to provide quality. These include: altruistic motives, cost structure, number of providers, demand responsiveness, GP gatekeeping, degree of specialization, profit constraints and soft budgets. We also review the theoretical literature on choice across different countries (e.g. within the EU) or regions within the same countries. The chapter reviews selected empirical studies that investigate whether demand responds to quality and waiting times, the role of patient's mobility and the effect of competition on quality. PMID:24864380
Brekke, Kurt R; Gravelle, Hugh; Siciliani, Luigi; Straume, Odd Rune
Use of tobacco, alcohol and other drugs plays a major role in adolescent morbidity and mortality. When under the influence of alcohol or other drugs, adolescents are at increased risk for injuries, unprotected sex, or interpersonal violence. Alcohol and other drugs are major factors in adolescent deaths, contributing to motor vehicle crashes, homicides, and suicides. Adolescents tend to have shorter substance use histories therefore they often experience emergency/acute care health treatment resulting from substance use related trauma and/or overdose. Substance use screening of adolescents who present to an Emergency Department (ED) is vitally important. The CRAFFT is a valid and reliable screening tool that was developed for use with adolescents. If an adolescent screens positive, then the next step is to determine their stage of use and readiness for change in preparation for doing a brief intervention. Helping patients to recognize the potential relation between their substance use and health related consequences, may motivate them to decrease their use for harm reduction. Motivational interviewing is an effective, evidence-based approach to helping people change their high risk behavior. PMID:16280955
Burke, Pamela J; O'Sullivan, Joanne; Vaughan, Brigid L
Objective To understand key adaptive strategies considered by health care safety net organizations serving uninsured and underinsured populations in Michigan. Data Sources/Study Setting Primary data collected through interviews at community-based free clinics, family planning clinics, local public health departments, and Federally Qualified Health Centers from 2002 to 2003. Research Design In each of six service areas in Michigan, we conducted a multiple-site case study of the four organizations noted above. We conducted interviews with the administrator, the medical or clinical director, the financial or marketing director, and a member of the board of directors. We interviewed 74 respondents at 20 organizations. Principal Findings Organizations perceive that unmet need is expanding faster than organizational capacity; organizations are unable to keep up with demand. Other threats to survival include a sicker patient population and difficulty in retaining staff (particularly nurses). Most clinics are adopting explicit business strategies to survive. To maintain financial viability, clinics are: considering or implementing fees; recruiting insured patients; expanding fundraising activities; reducing services; or turning away patients. Collaborative strategies, such as partnerships with hospitals, have been difficult to implement. Clinics are struggling with how to define their mission given the environment and threats to survival. Conclusions Adaptive strategies remain a work in progress, but will not be sufficient to respond to increasing service demands. Increased federal funding, or, ideally, a national health insurance program, may be the only viable option for expanding organizational capacity.
Jacobson, Peter D; Dalton, Vanessa K; Berson-Grand, Julie; Weisman, Carol S
Recent research has revealed child care settings and providers to be important influences on children's developing behaviors. Yet most research on children's nutritional development has focused on home settings and parents. Thus, through semistructured interviews with child careproviders, this study aimed to develop a better understanding of the strategies they perceive to encourage healthy eating in child care settings.
Despite the high prevalence of hepatitis C virus (HCV) infection among injection drug users also infected with human immunodeficiency virus (HIV), and the synergistic adverse effect of the two diseases on patients' health and survival, research on the clinical management of these patients and particularly the low uptake of HCV therapy is limited. We conducted qualitative interviews with 17 HIV providers from two urban public hospitals. We discovered that the limitations of the current state of medical knowledge, the severe side effects of HIV and HCV therapies, and the psychosocial vulnerability of HIV/HCV-coinfected patients combined with their resistance to becoming informed about HCV posed significant challenges for providers. To contend with these challenges, providers incorporated key dimensions of patient-centered medicine in their practice, such as considering their patients' psychosocial profiles and the meaning patients assign to being coinfected, and finding ways to engage their patients in a therapeutic alliance. PMID:21825278
Lekas, Helen-Maria; Siegel, Karolynn; Leider, Jason
The care of patients with cancer not only involves dealing with its symptoms but also with complicated information and uncertainty; isolation; and fear of disease progression, disease recurrence, and death. Patients whose treatments require them to go without human contact can find a lack of touch to be an especially distressing factor. Massage therapy is often used to address these patients' need for human contact, and findings support the positive value of massage in cancercare. Several reviews of the scientific literature have attributed numerous positive effects to massage, including improvements in the quality of patients' relaxation, sleep, and immune system responses and in the relief of their fatigue, pain, anxiety, and nausea. On the basis of these reviews, some large cancer centers in the United States have started to integrate massage therapy into conventional settings. In this paper, we recognize the importance of touch, review findings regarding massage for cancer patients, describe the massage therapy program in one of these centers, and outline future challenges and implications for the effective integration of massage therapy in large and small cancer centers. PMID:18315504
Russell, Nancy C; Sumler, Sat-Siri; Beinhorn, Curtiss M; Frenkel, Moshe A
Hospitals can be reimbursed for their costs in many ways. Several authors have investigated the effects of these reimbursement rules on physician incentives and, therefore, on the quantity of services provided to patients. A form of (linear) cost-sharing tends to emerge as the socially efficient reimbursement policy. The authors present a model of hospital reimbursement, based on Ellis and McGuire
As part of an overall evaluation of the Alaska Health System's response to the problem of alcoholism, the attitudes of all levels of health providers toward mental health problems were examined. The evaluation instrument was the Opinions About Mental Illness Scale developed by Cohen and Struening. Health workers from physicians to paraprofessional aides were tested and the results scored and
Lawrence Berg; Sheldon Miller; Edward Helmick; Paul Nutting; Gregory Shorr
Guided by life course and stress process theory, this study investigated pathways of adult child caregivers' family (caregiving, marital, parenting) and nonfamily (employment) roles. Eight waves of data from the Health and Retirement Study were analyzed for 1,300 adult child caregivers. Latent class analysis provided strong evidence for a 4-class…
Purpose: The aim of this study was to document the experience and patient satisfaction with providing pediatric surgery consultations and follow-up appointments to remote locations via audiovisual telecommunications technology. Methods: From January 2000 to April 2001, 16 consecutive pediatric general surgery clinics were reviewed for the type of patient (new or review), the diagnosis, the adequacy and accuracy of the
A significant proportion of adult breast cancer survivors experience deficits in function and restriction in participation in life roles that may remain many years after diagnosis. Function is a complex construct that takes into account the interactions between an individual, their health condition, and the social and personal context in which they live. Research to date on limitations in activities of daily living, upper extremity function, and functional capacity in breast cancer survivors illustrates the need for prospective measurement of function using measures that are sensitive to the unique issues of breast cancer survivors and the need for the development of effective rehabilitation interventions to improve function. Limitations in function have a significant impact on quality of life, but less is known about the implications on return to work and survival, as well as the impact of other comorbidities and aging on the function limitations in breast cancer survivors. This review provides a rationale for the integration of measures of function into breast cancercare to more fully appreciate the functional limitations associated with breast cancer diagnosis and treatment and to aid in the development of better rehabilitation care for breast cancer survivors. PMID:22488704
Campbell, Kristin L; Pusic, Andrea L; Zucker, David S; McNeely, Margaret L; Binkley, Jill M; Cheville, Andrea L; Harwood, Kenneth J
The use of complementary therapies by patients with cancer is increasingly common, despite limited evidence for their efficacy and safety. The widespread use of complementary therapies has major implications for research and practice. In this paper, we provide an overview of the current state of knowledge regarding issues related to the use of complementary therapies by patients with cancer. So
Maria J. Verhoef; Robert J. Hilsden; Maeve O’Beirne
This Special Listing of Current Cancer Research Projects is a publication of the International Cancer Research Data Bank (ICRDB) Program of the National Cancer Institute. Each Listing contains descriptions of ongoing projects in one selected cancer research area. The research areas include: Infectious disease in cancer patients; Immunological aspects of supportive care of cancer patients; Nutritional evaluation and support of cancer patients; Pain management of cancer patients.
Introduction A severe healthcare worker shortage in sub-Saharan Africa is inhibiting the expansion of HIV treatment. Task shifting, the transfer of antiretroviral therapy (ART) management and initiation from doctors to nurses and other non-physician clinicians, has been proposed to address this problem. However, many health officials remain wary about implementing task shifting policies due to concerns that non-physicians will providecare inferior to physicians. To determine if non-physician-provided HIV care does result in equivalent outcomes to physician-providedcare, a meta-analysis was performed. Methods Online databases were searched using a predefined strategy. The results for four primary outcomes were combined using a random effects model with sub-groups of non-physician-managed ART and -initiated ART. TB diagnosis rates, adherence, weight gain and patient satisfaction were summarized qualitatively. Results Mortality (N=59,666) had similar outcomes for non-physicians and physicians, with a hazard ratio of 1.05 (CI: 0.88–1.26). The increase in CD4 levels at one year, as a difference in means of 2.3 (N=17,142, CI: ?12.7–17.3), and viral failure at one year, as a risk ratio of 0.89 (N=10,344, CI: 0.65–1.23), were similar for physicians and non-physicians. Interestingly, loss to follow-up (LTFU) (N=53,435) was reduced for non-physicians with a hazard ratio of 0.72 (CI: 0.56–0.94). TB diagnosis rates, adherence and weight gain were similar for non-physicians and physicians. Patient satisfaction appeared higher for non-physicians in qualitative components of studies and was attributed to non-physicians spending more time with patients as well as providing more holistic care. Conclusions Non-physician-provided HIV care results in equivalent outcomes to careprovided by physicians and may result in decreased LTFU rates.
Emdin, Connor A; Chong, Nicholas J; Millson, Peggy E
This paper presents a qualitative investigation of the work-family support roles of a sample of 29 child careproviders serving low-income families in the Chicago area (16 family, friend, and neighbor providers (FFN), 7 licensed family child careproviders (FCC), and 6 center-based teachers). Providers report offering low-income parents…
The NCI, in collaboration with the Department of Veterans Affairs (VA), supported a research consortium of eight grantees to measure the quality of cancercare and associated health outcomes in the United States. This project, entitled "CancerCare Outcomes Research and Surveillance Consortium" (CanCORS), supported prospective research in a cohort of approximately 10,000 patients with newly diagnosed lung cancer or colorectal cancer recruited from geographically diverse populations and health care systems.
In this chapter the "communication compass" is introduced. It defines the key elements of communication and provides a language with which to communicate about communication in cancercare. The communication compass consists of two axes. One axis defines the associated perspectives of the clinician and the patient, the other axis the content of information and emotional experience. "Two lovers sat on a park bench with their bodies touching each other, holding hands in the moonlight. There was silence between them. So profound was their love for each other, they needed no words to express it." (Samuel Johnson). Sometimes communication just flows. There are these special moments, as fleeting as they are intense. Often communication is stuck. It is as if we speak another language and never manage to understand one another. The lovers on the park bench need no words to express what they feel, neither do they need words to speak about communication. Where communication gets stuck, we need a suitable language to speak about communication. Professional communication cannot be learned from a cookbook. Most of all it implies a readiness to communicate, which means openness to the other. The old adage that it is impossible not to communicate is only true if no criterion of quality is applied. As soon as some mutual understanding is implied in the definition of communication, the fact that it is at all possible to communicate becomes a miracle. Since there is an important gap between theory and practice, we created a tool that aims to bridge that gap. We call it the communication compass. It does not propose a model of "ideal communication," but provides a language with which to examine and analyze specific situations and to determine what the pitfalls and possibilities are. It is useful as a tool for identifying communicational difficulties in daily clinical practice and it can serve as a model for training basic communication skills. PMID:17073187
Patients' experiences after receiving care from emergency care practitioners (ECPs) were compared with those after receiving care from traditional ambulance practitioners using a postal questionnaire distributed to 1658 patients in London; 888 responses were received. The responses of patients receiving care from both groups were similar and largely positive. But in two areas (“thoroughness of assessment” and “explaining what would happen next”), the careprovided by ECPs was experienced as considerably better. These differences were partly explained by considerably fewer patients from ECPs being conveyed to the emergency department, suggesting that empowering ECPs to explore and explain alternatives to the emergency department improves patient satisfaction.
Primary care settings are the gateway through which the majority of Latinos access care for their physical and mental health concerns. This study explored the perspectives of primary careproviders concerning their Latino patients, in particular issues affecting their patients' access to and utilization of services. Interviews were conducted with…
Valdez, Carmen R.; Dvorscek, Michael J.; Budge, Stephanie L.; Esmond, Sarah
...Agreements for State Home Nursing Home Care AGENCY: Department of Veterans Affairs...agreements with State homes for the nursing home care of certain disabled veterans. This rulemaking...in law that revises how VA will pay for careprovided to these veterans and...
This study evaluated primary careproviders' (PCPs, pediatricians, and nurse practitioners) knowledge, current practices, and perceived barriers to childhood obesity prevention and treatment, with an emphasis on first-year well-child care visits. A questionnaire was distributed to 192 PCPs in the primary care network at The Children's Hospital of Philadelphia (CHOP) addressing (i) knowledge of obesity and American Academy of Pediatrics
Jordan G. Spivack; Maggie Swietlik; Evaline Alessandrini; Myles S. Faith
This article examines motivations for entering family day care work as they relate to responsibilities of motherhood and the prominence of these motivations for the women providing day care within and across groups of workers. Using data from a large-scale representative survey of family day care workers in Illinois, the author examines the range…
The ten largest employer child care management organizations, as a group, reported a zero growth rate in 2004. This year of no growth follows two years in which the sector grew by only 4% per year. This contrasts dramatically with the fast expansion period for employer child care, 1996 through 2000, when the sector grew at an annual rate of 10%.…
Optimizing patient experiences with care is especially important in cancer because cancercare is often complex and involves communication with and coordination across providers of multiple specialties and across multiple institutional settings. Unsatisfactory interactions with the health care system pose an additional burden on patients when they are already ill and vulnerable. More importantly, less-than-optimal patient experiences can have a significant negative impact on patients’ health-related quality of life.
This manual provides a reference source for use by sponsor organizations of the Child and Adult Care Food Program (CACFP) in training family child careproviders. The manual begins with separate introductory sections for trainers and for providers. The trainer's section includes materials on: how adults learn, strengths and limitations of various…
Background: Information on the costs of medical care for patients enrolled in clinical trials is needed by policymakers evaluating ways to facilitate clinical research in a managed care environment. We examined the direct costs of medical care for patients enrolled in cancer clinical trials at a large health maintenance organization (HMO). Methods: Costs for 135 patients who entered 22 cancer
Bruce H. Fireman; Louis Fehrenbacher; Elisabeth P. Gruskin; G. Thomas Ray
Communication problems due to language and cultural differences between health care professionals and patients are widely\\u000a recognized. Finns are described as more silent whereas one concurrent large immigrant group, the Somalis, are described as\\u000a more open in their communication. The aim of the study was to explore physicians-nurses\\/midwives’ communication when providing\\u000a reproductive and maternity health care to Somali women in
Filio Degni; Sakari Suominen; Birgitta Essén; Walid El Ansari; Katri Vehviläinen-Julkunen
The care of head and neck squamous cell carcinoma has greatly evolved over the past 30 years. From single modality to a multidisciplinary care, there has also been a concurrent increase in treatment intensity, resulting, at many times, in more zealous regimens that patients must endure. In this article, we apply Porter's value model as a framework to balance survival, toxicities, cost, and trade-offs from a patient's perspective in head and neck cancer. This model defines value as the health outcome per dollar achieved. Domains and outcomes that are important to patients, including not only survival or short-term quality of life, but also functional outcomes, recovery, sustainability of recovery, and the lasting consequences of therapy are included in this framework. Other outcomes that are seldom measured in head and neck cancer, such as work disability and financial toxicities, are also included and further discussed. Within this value model and based on evidence, we further discuss de-escalation of care, intensity-modulated radiation therapy, newer surgical methods, and enhancements in the process of care as potential approaches to add value for patients. Finally, we argue that knowing the patient's preferences is essential in the value discussion, as the attribute that will ultimately provide the most value to the individual patient with head and neck cancer. PMID:24857117
Background In larger parts of the Middle East palliative care is still misunderstood among health professionals, cancer patients and the public at large. One reason to that is because the term does not obviously communicate the intent of this clinical discipline, which is lending better quality of life while combating cancer. Further, culture, tradition and religion have contributed to this misgiving and confusion especially at the terminal stage of the disease. Methods The Middle East Cancer Consortium jointly with the American Society of Clinical Oncology, the American Oncology Nursing Society, the San Diego Hospice Center for Palliative Medicine and the Children's Hospital & Clinics of Minnesota initiated a series of training courses and workshops in the Middle East to provide updated training to physicians, nurses, social workers and psychologists from throughout the region with basic concepts of palliative care and pain managements in adults and children cancers. Results During the past 6 years hundreds of professionals took part in these educational and training activities, thereby creating the core of trained caregivers who start to make the change in their individual countries. Conclusions The outcome of consecutive training activities can overcome geopolitical instabilities, and yield a genuine change in approach of both regulators, medical administrators, medical staff and the public; as to the important contribution of palliative care services to the welfare of the patient and his/her family.
Silbermann, M.; Arnaout, M.; Daher, M.; Nestoros, S.; Pitsillides, B.; Charalambous, H.; Gultekin, M.; Fahmi, R.; Mostafa, K.A.H.; Khleif, A.D.; Manasrah, N.; Oberman, A.
Objective Our understanding of optimum health care delivery for cancer survivors is limited by the lack of a patient-centred perspective. The objectives of the present study were to explore the views of breast and colorectal cancer survivors on their routine follow-up care, with respect to needs, preferences, and quality of follow-up, and their views on cancer specialist– compared with family physician (fp)–led follow-up care. Methods In Nova Scotia, Canada, 23 cancer survivors (13 breast, 10 colorectal) participated in either a focus group or a one-on-one interview. Participants were asked to reflect upon their lives as cancer survivors and on the type and quality of care and support they received during the follow-up period. Each focus group or interview was transcribed verbatim, and the transcripts were audited and subjected to a thematic analysis. Results Six themes were identified: My care is my responsibilityHow I receive information on follow-up careI have many care needsI want to be prepared and informedThe role of my fp in my cancer experience and follow-up careThe role of media Survivors often characterized the post–primary treatment experience as lacking in information and preparation for follow-up and providing inadequate support to address many of the care needs prevalent in survivor populations. Despite valuing fp participation in follow-up care, many survivors continued to receive comfort and reassurance from specialist care. Conclusions Our findings point to the need to implement strategies that better prepare breast cancer and colorectal cancer survivors for post-treatment care and that reassure survivors of the ability of their fp to provide quality care during this period.
Urquhart, R.; Folkes, A.; Babineau, J.; Grunfeld, E.
We compared perceptions about the practice environment and the job satisfaction of physician assistants (PAs), nurse practitioners (NPs), and primary care physicians in a large group–model HMO. The data source was a self-administered mail survey (average response rate = 79%). PA\\/NPs and primary care physicians reported that professional autonomy was not a problem and were satisfied with most aspects of
Donald K. Freeborn; Roderick S. Hooker; Clyde R. Pope
Colorectal cancer is a great concern for the American Indian/Alaska Native (AI/AN) community, as incidence and mortality rates remain high and screening rates stay low. We conducted interviews with community leaders (n=13) and with providers from the Indian Health Service (IHS), tribal clinics, and urban safety-net clinics (n=17) in Northeast Kansas and the Kansas City Metro Area to determine their understanding of needs and barriers to colorectal cancer screening among American Indians. Using a community-based participatory research (CBPR) approach for this pilot study, community leaders and providers identified similar needs, including: culturally-appropriate education about colorectal cancer and screenings, the potential use of Native elders as patient navigators, and an emphasis on preventive care, particularly through the IHS. Barriers included culturally specific issues such as historic mistrust and gender roles. Other barriers are similar to members of other ethnic groups, such as cost, transportation, fear, and repulsion toward the screening process.
Daley, Christine Makosky; James, Aimee S.; Filippi, Melissa; Weir, Maria; Braiuca, Stacy; Kaur, Baljit; Choi, Won S.; Greiner, K. Allen
Successful adaptation to chronic illness is enhanced by active client-health careprovider partnerships. The purposes of this article are to (a) examine the health care partnership needs of western rural women with chronic illness who participated in a computer-based support and education project, (b) describe how the role of the women in the partnership can be maximized by the use of a personal health record and improving health literacy, and (c) discuss ways health careproviders can enhance their role in the partnership by careful listening and creating environments conducive to forging productive client-provider partnerships. PMID:20651303
Cudney, Shirley; Weinert, Clarann; Kinion, Elizabeth
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) identified patients report receiving substandard care from healthcare providers. They face the fear and disturbing reality of discrimination when accessing health care. Without culturally sensitive treatment, nursing and other health professions do not properly care for this population. Following the recent trend towards awareness and need for inclusion of LGBTQ populations in healthcare, this paper provides a summary of the current literature on the treatment and needs of LGBTQ people and describes focus groups conducted to explore perceptions regarding provider behaviors. It concludes with a list of behaviors that enhance or impede quality care that can serve as a guide for healthcare professionals. PMID:23721392
Rounds, Kelsey E; McGrath, Barbara Burns; Walsh, Elaine
Background Continuity is an important aspect of quality of care, especially for complex patients in the community. We explored provider perceptions of continuity through a system’s lens. The circle of care was used as the system. Methods Soft systems methodology was used to understand and improve continuity for end of life patients in two communities. Participants: Physicians, nurses, pharmacists in two communities in British Columbia, involved in end of life care. Two debates/discussion groups were completed after the interviews and initial analysis to confirm findings. Interview recordings were qualitatively analyzed to extract components and enablers of continuity. Results 32 provider interviews were completed. Findings from this study support the three types of continuity described by Haggerty and Reid (information, management, and relationship continuity). This work extends their model by adding features of the circle of care that influence and enable continuity: Provider Connectedness the sense of knowing and trust between providers who share care of a patient; a set of ten communication patterns that are used to support continuity across the circle of care; and environmental factors outside the circle that can indirectly influence continuity. Conclusions We present an extended model of continuity of care. The components in the model can support health planners consider how health care is organized to promote continuity and by researchers when considering future continuity research.
New health care delivery and payment models in the private sector are being shaped by active collaboration between health insurance plans and providers. We examine key characteristics of several of these private accountable care models, including their overall efforts to improve the quality, efficiency, and accountability of care; their criteria for selecting providers; the payment methods and performance measures they are using; and the technical assistance they are supplying to participating providers. Our findings show that not all providers are equally ready to enter into these arrangements with health plans and therefore flexibility in design of these arrangements is critical. These findings also hold lessons for the emerging public accountable care models, such as the Medicare Shared Savings Program-underscoring providers' need for comprehensive and timely data and analytic reports; payment tailored to providers' readiness for these contracts; and measurement of quality across multiple years and care settings. PMID:21900663
Early childhood is a critical period for shaping and influencing feeding and lifestyle behaviors that have implications for future weight and health. With more women in the workforce, families have become reliant on child care. Thus, the child-feeding relationship has become a shared responsibility between the parent and child-careprovider. Little is known about the impact of child-careproviders on
The aim of this chapter is to show how discrete choice experiments (DCEs) can be applied to examine the preferences of health\\u000a careproviders. Health careproviders comprise health care organisations and health professionals employed within them. Health\\u000a professionals make decisions about their supply of labour in addition to clinical decisions. A key policy issue across many\\u000a developed and developing
Anthony Scott; Cristina Ubach; Fiona French; Gillian Needham
Background Approximately 1.7 million Americans are diagnosed with cancer annually. There is an increasing demand for high-quality cancercare; however, what constitutes quality care is not well defined. There remains a gap in our knowledge regarding the current perceptions of what defines quality care. Objective To review the current understanding and perspectives of key stakeholders regarding quality cancercare for adult patients with cancer who are receiving chemotherapy-based treatment regimens. Methods This systematic qualitative literature review involved a search of MEDLINE and PubMed databases for articles that were published between January 2009 and May 2013 using a predefined search strategy with specific Medical Subject Headings terms encompassing 3 core concepts—cancer, chemotherapy, and quality of healthcare. Articles were eligible to be included if they focused on adult cancers, discussed quality indicators of cancercare or quality of care in the article's body, discussed treating cancer with chemotherapy, were conducted in the United States and with US respondents, and reported data about cancer quality that were obtained directly from stakeholders (eg, patients, caregivers, providers, payers, other healthcare professionals). Thematic analyses were conducted to assess the perspectives and the intersection of quality care issues from each stakeholder group that was identified, including patients, providers, and thought leaders. Results The search strategy identified 542 articles that were reviewed for eligibility. Of these articles, 15 were eligible for inclusion in the study and reported perspectives from a total of 4934 participants. Patients with cancer, as well as providers, noted information needs, psychosocial support, responsibility for care, and coordination of care as important aspects of quality care. Providers also reported the importance of equity in cancercare and reimbursement concerns, whereas patients with cancer considered the timeliness of care an important factor. The perspectives of thought leaders focused on barriers to and facilitators of quality care. Conclusion Thematic elements related to cancer quality were relatively consistent between patients and providers; no additional information was found regarding payer perspectives. The perspectives of these groups are important to consider as quality initiatives are being developed.
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Care coordination has been a key theme in national forums on healthcare quality, design, and improvement. This article describes the characteristics of a care coordination program aimed at supporting families in building care coordination competencies and providers in the coordination of care across multiple specialties. The program included implementation of a Care Coordination Counselor (CC Counselor) and several supporting tools-Care Binders, Complex Scheduling, Community Resources for Families Database, and a Care Coordination Network. Patients were referred by a healthcare provider to receive services from the CC Counselor or to receive a Care Binder organizational tool. To assess the impact of the counselor role, we compared patient experience survey results from patients receiving CC Counselor services to those receiving only the Care Binder. Our analysis found that patients supported by the CC Counselor reported greater agreement with accessing care coordination resources and identifying a key point person for coordination. Seventy-five percent of CC Counselor patients have graduated from the program. Our findings suggest that implementation of a CC Counselor role and supporting tools offers an integrative way to connect patients, families, and providers with services and resources to support coordinated, continuous care. PMID:22913270
Background: cancer patients require palliative care. Aim: the purpose of this study was to explore the experiences of nurses, who provide palliative care for cancer patients, within the context of Iranian culture. Methods: we conducted a hermeneutic phenomenological study. Semi structured in-depth interviews with 10 nurses were audio taped and transcribed. The transcriptions were then analyzed by Van Manen’s method. Results: one of the most important themes that emerged was “human relationships”, which also contained the subthemes of “comprehensive acceptance” and “psychological support”. Conclusions: the results provide deep understanding of human relationships in palliative care of cancer patients in Iran.
Measuring and projecting the economic burden associated with cancer and identifying effective policies for minimizing its impact are increasingly important issues for health care policy makers and health care systems at multiple levels.
Literature related to health care professionals dealing with stress of cancercare is still in its infancy. The authors distinguish papers of general interest (the most frequent), papers identifying stressors, and papers about stress consequences. Most of them recognize death of the patients as a major stressor for health care professionals. There are also additional stressors specific to health care
Nicole Delvaux; Darius Razavi; Christine Farvacques
NCI has supported a number of studies that investigate the cost of patient care for patients enrolled in NCI-sponsored clinical trials compared to care received for comparable patients in standard community care. These data are essential to inform ongoing policy debates about the financial coverage by public and private health insurance plans of care received in cancer clinical trials.
The Centers for Disease Control and Prevention have recommended that HIV care clinics incorporate prevention into clinical practice. This report summarizes HIV careproviders' attitudes and counseling practices before and after they received training to deliver a counseling intervention to patients. Providers at seven HIV clinics received training…
Thrun, Mark; Cook, Paul F.; Bradley-Springer, Lucy A.; Gardner, Lytt; Marks, Gary; Wright, Julie; Wilson, Tracey E.; Quinlivan, E. Byrd; O'Daniels, Christine; Raffanti, Stephen; Thompson, Melanie; Golin, Carol
This reports that health careproviders, including those based in schools, can be instrumental in efforts to enroll eligible children in Medicaid or low-cost health insurance. There are 10 ways in which health careproviders can help: (1) inform families about the availability of free and low-cost health insurance for children; (2) enlist all…
This study used a hermeneutical methodology to explore how Computer Mediated Communication (CMC) can be used to provide pastoral care to youth in a high tech world. The research was motivated by the writers desire to find ways to be in communication with youth and provide pastoral care to them during their adolescent years. The thesis will explore computer mediated
Partnership between health careproviders and patients is important for controlling illness. A limited number of studies show how to assess health professionals' communication and partnering behavior. The relationship between these aspects of professional behavior and enhanced management of disease by patients has received little empirical study. The research reported here developed a Health CareProviders' Teaching and Communication Behavior
Noreen M. Clark; Molly Gong; M. Anthony Schork; Lois A. Maiman; David Evans; Martin E. Hurwitz; Dietrich Roloff; Robert B. Mellins
A survey of 414 child careproviders in southeastern Wisconsin reveals that cost as well as low wages and lack of benefits for workers can constrain providers from pursuing improvements to child-care quality. Of survey respondents, approximately half of whom are home-based and half center-based, 13% have at least three of five structural factors…
Noting that in many areas, family child careproviders lack both available training to enhance their professional skills and an organized professional network for continual support, this practicum project implemented and evaluated the effectiveness of a curriculum to prepare family child careproviders for state certification through a community…
The authors conducted a needs assessment among students and health-careproviders of a southwestern university health center with the goal of developing health-care -provider training addressing substance-abuse screening and intervention. They collected data from focus groups of undergraduate students and structured interviews and questionnaires…
Purpose – The purpose of this paper is to examine social policy recommendations to deal with the high level of pressure placed upon informal providers of elder care. Design\\/methodology\\/approach – The paper investigates this subject of elder care by first establishing the significance of the problem. The paper provides an examination of how this problem is dealt with in several
The Global Cancer Genomics Consortium (GCGC) is a cohesive network of oncologists, cancer biologists and structural and genomic experts residing in six institutions from Portugal, United Kingdom, Japan, India, and United States. The team is using its combined resources and infrastructures to address carefully selected, shared, burning questions in cancer medicine. The Third Annual Symposium was organized by the Institute of Molecular Medicine, Lisbon Medical School, Lisbon, Portugal, from September 18 to 20, 2013. To highlight the benefits and limitations of recent advances in cancer genomics, the meeting focused on how to better translate our gains in oncogenomics to cancer patients while engaging our younger colleagues in cancer medicine at-large. Over two hundreds participants actively discussed some of the most recent advances in the areas cancer genomics, transcriptomics and cancer system biology and how to best apply such knowledge to cancer therapeutics, biomarkers discovery and drug development, and an essential role played by bio-banking throughout the process. In brief, the GCGC symposium provided a platform for students and translational cancer researchers to share their excitement and worries as we are beginning to translate the gains in oncogenomics to a better cancer patient treatment.
This research aims to increase transparency and simplify consumer decision-making regarding the selection of a home health careprovider. Currently, quality information on home health careproviders is fragmented and difficult to interpret. In this study, a quality-ranking model is developed by selecting multidimensional quality indicators across multiple sources and respective weights using expert judgment. Given the weights and providers' performance on each quality indicator, a composite score is calculated that summarizes a home health careprovider's overall quality level. This quality information empowers consumers to narrow their search and select the best-performing, most efficient providers. PMID:23924223
Monitoring the current status of cancercare is essential for effective cancer control and high-quality cancercare. To address the information needs of patients and physicians in Japan, hospital-based cancer registries are operated in 397 hospitals designated as cancercare hospitals by the national government. These hospitals collect information on all cancer cases encountered in each hospital according to precisely defined coding rules. The Center for Cancer Control and Information Services at the National Cancer Center supports the management of the hospital-based cancer registry by providing training for tumor registrars and by developing and maintaining the standard software and continuing communication, which includes mailing lists, a customizable web site and site visits. Data from the cancercare hospitals are submitted annually to the Center, compiled, and distributed as the National Cancer Statistics Report. The report reveals the national profiles of patient characteristics, route to discovery, stage distribution, and first-course treatments of the five major cancers in Japan. A system designed to follow up on patient survival will soon be established. Findings from the analyses will reveal characteristics of designated cancercare hospitals nationwide and will show how characteristics of patients with cancer in Japan differ from those of patients with cancer in other countries. The database will provide an infrastructure for future clinical and health services research and will support quality measurement and improvement of cancercare. Researchers and policy-makers in Japan are encouraged to take advantage of this powerful tool to enhance cancer control and their clinical practice. PMID:23448800
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The current study sought to define best practice for timeliness for a breast cancer program at each diagnostic step. The study was a retrospective review of patients newly diagnosed with invasive breast cancer who were enrolled in the breast cancer database from 2009-2011. A convenience sampling methodology was used for patient selection, and descriptive statistics for various time intervals were calculated for identified data points from abnormal imaging to surgery. No evidence-based practice standards exist for access to breast cancercare. Practice guidelines that include benchmarks for quality measures and an established process to measure patient outcomes would promote high-quality care. An understanding of how practice sites function also would help healthcare providers identify and develop resources to improve patient outcomes. In the current study, the advanced practice nurse (APN) in the practice setting was identified as a key point person in facilitating patients' timely access to healthcare services. The physician and APN practice model was instrumental in influencing the process. The results of the current study provided clinical data to identify benchmarks that a breast oncology practice can use to monitor timeliness as a quality indicator. PMID:24476729
The volume contains information on screening programs; education; diagnosis; grading and prognostic procedures; therapy, treatment methods; supportive care of patients; rehabilitation and clinical cancer data processing.
Background As part of a comprehensive study on the primary health care system in Iraq, we sought to explore primary careproviders’ perspectives about the main problems influencing the provision of primary care services and opportunities to improve the system. Methods A qualitative study based on four focus groups involving 40 primary careproviders from 12 primary health care centres was conducted in Erbil governorate in the Iraqi Kurdistan region between July and October 2010. A topic guide was used to lead discussions and covered questions on positive aspects of and current problems with the primary care system in addition to the priority needs for its improvement. The discussions were fully transcribed and the qualitative data was analyzed by content analysis, followed by a thematic analysis. Results Problems facing the primary care system included inappropriate health service delivery (irrational use of health services, irrational treatment, poor referral system, poor infrastructure and poor hygiene), health workforce challenges (high number of specialists, uneven distribution of the health workforce, rapid turnover, lack of training and educational opportunities and discrepancies in the salary system), shortage in resources (shortage and low quality of medical supplies and shortage in financing), poor information technology and poor leadership/governance. The greatest emphasis was placed on poor organization of health services delivery, particularly the irrational use of health services and the related overcrowding and overload on primary careproviders and health facilities. Suggestions for improving the system included application of a family medicine approach and ensuring effective planning and monitoring. Conclusions This study has provided a comprehensive understanding of the factors that negatively affect the primary care system in Iraq’s Kurdistan region from the perspective of primary careproviders. From their experience, primary careproviders have a role in informing the community and policy makers about the main problems affecting this system, though improvements to the health care system must be taken up at the national level and involve other key stakeholders.
The specificity of management of quality work of nurses during providing medical care to patients in an intensive care unit is considered in the article. It is noticed, that the quality of getting medical care to critically ill patients depends on psychological state of the staff. The key factors providing the qualitative work of the medical personnel with critically ill patients are follows as: preliminary occupational selection, team interaction, trainings, moral and financial work motivation, effective system of control of medical care and consideration of mistakes. The instruments for quality control and reasons raising risks of nurse mistakes are presented in the article. PMID:18663945
Bogomaz, V M; Burmistenko, V A; Koren', A V; Sukhonogova, E N
Changing healthcare policy will undoubtedly affect the healthcare environment in which providers function. The current Fee for Service reimbursement model will be replaced by Value-Based Purchasing, where higher quality and more efficient care will be emphasized. Because of this, large healthcare organizations and individual providers must adapt to incorporate performance outcomes into patient care. Here, we present a Continuing Medical Education (CME)-based initiative at the City of Hope National Cancer Center that we believe can serve as a model for using CME as a value added component to achieving such a goal.
We developed this program for primary careproviders (PCPs) and public health professionals (PHPs) who are interested in increasing their understanding of the genetics of common chronic diseases and of the implications of genetics and genomics for their fields. The program differs from virtually all previous educational efforts in genetics for health professionals in that it focuses on the genetics of common chronic disease and on the broad principles that emerge when one views disease from the perspectives of variation and individuality, which are at the heart of thinking genetically. The CD-ROM introduces users to content that will improve their understanding of topics such as: • A framework for genetics and common disease; • Basic information on genetics, genomics, genetic medicine, and public health genetics, all in the context of common chronic disease; • The status of research on genetic contributions to specific common diseases, including a review of research methods; • Genetic/environmental interaction as the new “central dogma” of public health genetics; • The importance of taking and analyzing a family history; • The likely impact of potential gene discovery and genetic testing on genetic counseling and risk assessment and on the practices of PCPs and PHPs; • Stratification of populations into low-, moderate-, and high-risk categories; • The potential role of PCPs and PHPs in identifying high-risk individuals and families, in providing limited genetics services, and in referring to clinical genetics specialists; the potential for standard referral algorithms; • Implications of genetic insights for diagnosis and treatment; • Ethical, legal, and social issues that arise from genetic testing for common chronic diseases; and • Specific prevention strategies based on understanding of genetics and genetic/ environmental interactions. The interactive content – developed by experts in genetics, primary care, and public health – is organized around two case studies designed to appeal to primary careproviders (thrombophilia) and public health professionals (development of a screening grogram for colorectal cancer). NCHPEG has distributed more than 0000 copies of the CD-ROM to NCHPEG member organizations and to other organizations and individuals in response to requests. The program also is available at www.nchpeg.org.
McInerney, Joseph D.; Greendale, Karen; Peay, Holly L.
Oral cancer accounts for 2 percent to 4 percent of all cancers diagnosed each year in the United States. In contrast to other cancers, the overall U.S. survival rate from oral cancer has not improved during the past 50 years, mostly due to late-stage diagnosis. Several noninvasive oral cancer detection techniques that emerged in the past decade will be discussed, with a brief overview of most common oral cancer chemopreventive agents.
MESSADI, DIANA V.; WILDER-SMITH, PETRA; WOLINSKY, LAWRENCE
Rationale: Minority patients with lung cancer are less likely to receive stage-appropriate treatment. Along with access to care and provider-related factors, cultural factors such as patients' lung cancer beliefs, fatalism, and medical mistrust may help explain this disparity. Objectives: To determine cultural factors associated with disparities in lung cancer treatment. Methods: Patients with newly diagnosed lung cancer were recruited from four medical centers in New York City from 2008 to 2011. Using validated tools, we surveyed participants about their beliefs regarding lung cancer, fatalism, and medical mistrust. We compared rates of stage-appropriate treatment among blacks, Hispanics, and nonminority patients. Multiple regression analyses and structural equation modeling were used to assess whether cultural factors are associated with and/or mediate disparities in care. Measurements and Main Results: Of the 352 patients with lung cancer in the study, 21% were black and 20% were Hispanic. Blacks were less likely to receive stage-appropriate treatment (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.27-0.93) compared with whites, even after adjusting for age, sex, marital status, insurance, income, comorbidities, and performance status. No differences in treatment rates were observed among Hispanics (OR, 1.05; 95% CI, 0.53-2.07). Structural equation modeling showed that cultural factors (negative surgical beliefs, fatalism, and medical mistrust) partially mediated the relationship between black race and lower rates of stage-appropriate treatment (total effect: -0.43, indirect effect: -0.13; 30% of total effect explained by cultural factors). Conclusions: Negative surgical beliefs, fatalism, and mistrust are more prevalent among minorities and appear to explain almost one-third of the observed disparities in lung cancer treatment among black patients. Interventions targeting cultural factors may help reduce undertreatment of minorities. PMID:24701981
Lin, Jenny J; Mhango, Grace; Wall, Melanie M; Lurslurchachai, Linda; Bond, Keosha T; Nelson, Judith E; Berman, Andrew R; Salazar-Schicchi, John; Powell, Charles; Keller, Steven M; Halm, Ethan A; Leventhal, Howard; Wisnivesky, Juan P
This final rule establishes the standard for a unique health identifier for health careproviders for use in the health care system and announces the adoption of the National Provider Identifier (NPI) as that standard. It also establishes the implementation specifications for obtaining and using the standard unique health identifier for health careproviders. The implementation specifications set the requirements that must be met by "covered entities": Health plans, health care clearinghouses, and those health careproviders who transmit any health information in electronic form in connection with a transaction for which the Secretary has adopted a standard (known as "covered health careproviders"). Covered entities must use the identifier in connection with standard transactions. The use of the NPI will improve the Medicare and Medicaid programs, and other Federal health programs and private health programs, and the effectiveness and efficiency of the health care industry in general, by simplifying the administration of the health care system and enabling the efficient electronic transmission of certain health information. This final rule implements some of the requirements of the Administrative Simplification subtitle F of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). PMID:14968800
We report on the nature and timing of services provided to children with an intellectual disability (ID) identified by a new comprehensive assessment and care planning tool used to evaluate children's needs for Medicaid Personal Care Services (PCS) in Texas. The new assessment procedure resulted from a legal settlement with the advocacy community. Participants in the study were 1,109 children ages 4-20 with an intellectual disability diagnosis who were assessed between January and April of 2010. The need for assistance is higher on Saturday and Sunday, when school services are not available. We report differences in service patterns for children who vary in ID severity. Finally, we consider the implications of our results for policies and programs that serve families with children with an ID. PMID:24635689
Elliott, Timothy R; Patnaik, Ashweeta; Naiser, Emily; Fournier, Constance J; McMaughan, Darcy K; Dyer, James A; Phillips, Charles D
Given the prevalence of human immunodeficiency virus (HIV) in veterans and that nearly 90% of veterans have not been HIV tested, the Veterans Affairs (VA) has recommended routine HIV testing of all veterans.The objective of this study carried out at an urban VA primary care clinic was to assess provider knowledge of recent U.S. Centers for Disease Control and Prevention (CDC) and VA HIV testing recommendations and policies. Fifty-six primary careproviders completed a survey. Nearly 40% of providers were unaware of the CDC recommendation to test all persons ages 13 to 64 in health care settings or the VA policy to test veterans of all ages. Over 75% of providers were unaware of the latest requirements for pre- and posttest counseling, and many were unaware of the latest consent process requirements. Educating VA providers about recent HIV testing recommendations and policies may improve the low HIV testing prevalence in the VA. PMID:23707836
Arya, Monisha; Bush, Amber L; Kallen, Michael A; Rodriguez-Barradas, Maria C; Giordano, Thomas P
Patient-centered home care is a new model of assistance, which may be integrated with more traditional hospital-centered care especially in selected groups of informed and trained patients. Patient-centered care is based on patients’ needs rather than on prognosis, and takes into account the emotional and psychosocial aspects of the disease. This model may be applied to elderly patients, who present comorbid diseases, but it also fits with the needs of younger fit patients. A specialized multidisciplinary team coordinated by experienced medical oncologists and including pharmacists, psychologists, nurses, and social assistance providers should carry out home care. Other professional figures may be required depending on patients’ needs. Every effort should be made to achieve optimal coordination between the health professionals and the reference hospital and to employ shared evidence-based guidelines, which in turn guarantee safety and efficacy. Comprehensive care has to be easily accessible and requires a high level of education and knowledge of the disease for both the patients and their caregivers. Patient-centered home care represents an important tool to improve quality of life and help cancer patients while also being cost effective.
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...purpose of religious nonmedical health care institutions providing home service...PROJECTS Religious Nonmedical Health Care Institutions-Benefits, Conditions...purpose of religious nonmedical health care institutions providing home...
...provider-related donations and health care-related taxes. 433.57 ...provider-related donations and health care-related taxes. Effective...donations and revenues generated by health care-related taxes received by...
To increase access and improve system quality and efficiency, President Obama signed the Patient Protection and Affordable Care Act with sweeping changes to the nation’s health-care system. Although not intended to be specific to cancer, the act's implementation will profoundly impact cancercare. Its components will influence multiple levels of the health-care environment including states, communities, health-care organizations, and individuals seeking care. To illustrate these influences, two reforms are considered: 1) accountable care organizations and 2) insurance-based reforms to gather evidence about effectiveness. We discuss these reforms using three facets of multilevel interventions: 1) their intended and unintended consequences, 2) the importance of timing, and 3) their implications for cancer. The success of complex health reforms requires understanding the scientific basis and evidence for carrying out such multilevel interventions. Conversely and equally important, successful implementation of multilevel interventions depends on understanding the political setting and goals of health-care reform.
Context: Mid-level providers comprise an increasing proportion of the health care workforce and play a key role in providing health services in rural and underserved areas. Although women comprise the majority of mid-level providers, they are less likely to work in a rural area than men. Maldistribution of health providers between urban and rural…
As the state of Illinois moves toward an integrated system of universally accessible early care and education, policymakers grapple with issues regarding who, where, how, and at what cost quality services should be provided. In order to inform this policy debate, this report describes the for-profit sector of Illinois' formal early care and…
Child care instructors and their aides at the Good Shepherd Day Care Center, Punta Gorda, Florida, were taught skills needed to develop classroom activities matching the cognitive development of 3- and 4-year-old children. Through a program of in-service activity in child growth and development, instruction was provided to enable teachers to more…
This study examines transitions in grandchild care and the characteristics of grandparents making these transitions, using longitudinal data from a nationally representative sample of 13,626 grandparents in the 1998-2008 Health and Retirement Study. More than 60% of grandparents provided grandchild care over the 10-year period; more than 70% of…
Luo, Ye; LaPierre, Tracey A.; Hughes, Mary Elizabeth; Waite, Linda J.
Several characteristics and perspectives of how Mexican Americans regard health care are presented for health careproviders. Following a brief discussion of culture and health, the guide describes the traditional and modern value orientations of Hispanics and the external forces that contribute to their adoption. Four key concepts to…
AIM: To assess the knowledge, attitudes and practices of primary health careproviders regarding the identification and management of domestic violence in a hospital based primary health care setting. METHOD: A survey of all clinicians and nursing staff of the outpatient, casualty and antenatal clinics in University Malaya Medical Centre using a self-administered questionnaire. RESULTS: Hundred and eight out of
Argues that continuous training is important for improving the quality of day-care provision. Social learning theory is used to examine David A. Kolb's experiential learning model as an approach to training day-careproviders. Concludes that attention must also be given to the creation of conditions under which experiential learning can be…
Step 2 of the Ten Steps of Mother-Friendly Care insures that women will have accurate, descriptive, and statistical information about the practices and procedures for birth care at their place of birth, including measures of interventions and outcomes. This information provides a foundation for making informed decisions. The rationales and evidence in support of this step are presented.
BackgroundThe rising cancer incidence in developing countries outpaces easy access to care. Time and effort spent on travel for care is a burden to patients and detracts from patient centredness, efficiency, and equitability. In Trinidad and Tobago, significant distress was observed among patients who made long journeys to the single public cancer clinic. The journey time among non-radiotherapy patients was
Obesity, (defined as body mass index [BMI] ?30), and especially morbid obesity (defined as BMI ?40), has a profound impact on the health and integrity of the patient's integumentary system and on the caregivers who strive to providecare for larger, heavy patients. The purpose of this overview is to address some common skin and wound care issues faced by bariatric patients in order to inform clinicians, patients, and caregivers and enable them to optimize care. For bariatric patients, extra attention must be paid to skin care, cleanliness, skin fold management, perigenital care, odor management, and effective pressure redistribution. Despite these interventions, the multifactorial challenges presented by morbid obesity increase patient risk for serious skin diseases and wound conditions. Implications for practice include how best to educate patients and caregivers for optimal problem prevention. Future research should target improving bariatric care equipment and decreasing risk indices. PMID:24434162
Cancer stem cells have been hypothesized to drive the growth and metastasis of tumors. Because they need to be targeted for\\u000a cancer treatment, they have been isolated from many solid cancers. However, cancer stem cells from primary human gastric cancer\\u000a tissues have not been isolated as yet. For the isolation, we used two cell surface markers: the epithelial cell adhesion
Background The majority of workers, regardless of age or occupational status, report engaging in personal Internet use in the workplace. There is little understanding of the impact that personal Internet use may have on patient care in acute clinical settings. Objective The objective of this study was to investigate the volume of one form of personal Internet use—online social networking (Facebook)—generated by workstations in the emergency department (ED) in contrast to measures of clinical volume and severity. Methods The research team analyzed anonymous network utilization records for 68 workstations located in the emergency medicine department within one academic medical center for 15 consecutive days (12/29/2009 to 1/12/2010). This data was compared to ED work index (EDWIN) data derived by the hospital information systems. Results Health care workers spent an accumulated 4349 minutes (72.5 hours) browsing Facebook, staff cumulatively visited Facebook 9369 times and spent, on average, 12.0 minutes per hour browsing Facebook. There was a statistically significant difference in the time spent on Facebook according to time of day (19.8 minutes per hour versus 4.3 minutes per hour, P<.001). There was a significant, positive correlation between EDWIN scores and time spent on Facebook (r=.266, P<.001). Conclusions Facebook use constituted a substantive percentage of staff time during the 15-day observation period. Facebook use increased with increased patient volume and severity within the ED.
A sample of 625 patients aged 18 to 65 with primary care visits was used to explore the relationship of disability prevention to patient health status and satisfaction with health careprovider. Disability prevention and the patient-provider relationship, the latter a potential mediating factor, were measured using reliable and valid scales. The joint effects of disability prevention and a strong patient-provider relationship were associated with decreased risks for poor physical health, as measured by the Medical Outcomes Study 12-item short-form health survey, decreased restricted activity days, and overall satisfaction with their primary careprovider. Patient-provider relationship was independently associated with increased patient satisfaction with the provider overall and endorsement of the provider to family or friends. The evidence questions the conventional wisdom among some primary careproviders that incorporating disability prevention principles into their daily practice jeopardizes patient satisfaction. These results suggest that primary careproviders with strong patient-provider relationships can successfully add disability prevention to their practice. PMID:11515254
Radosevich, D M; McGrail, M P; Lohman, W H; Gorman, R; Parker, D; Calasanz, M
Being adequately prepared for an experience such as cancer empowers patients, lowers distress, improves coping, supports self-management, promotes recovery, and improves quality of life. However, patients with cancer report unmet informational and support needs across the cancer trajectory. The purpose of this article is to describe the relationship of information preparation and patient outcomes, identify information and support needs across the cancer trajectory, and describe the role of oncology nurses in the delivery of high-quality patient-centered cancercare. The middle range theory of "Carrying On" was used to identify information and support needs during different phases of the cancer trajectory from treatment to survivorship. The authors concluded that nurses should engage the patient in a relational exchange of information; provide concrete, understandable information across specific times in the cancer experience; and use creative approaches to minimize barriers in meeting patient needs to achieve high-quality patient-centered cancercare. PMID:23715703
...needed to ensure that plan of care outcomes are achieved and negative outcomes are avoided. (b) Standard: Twenty-four hour nursing services. (1) The hospice facility must provide 24-hour nursing services that meet the...
...needed to ensure that plan of care outcomes are achieved and negative outcomes are avoided. (b) Standard: Twenty-four hour nursing services. (1) The hospice facility must provide 24-hour nursing services that meet the...
...needed to ensure that plan of care outcomes are achieved and negative outcomes are avoided. (b) Standard: Twenty-four hour nursing services. (1) The hospice facility must provide 24-hour nursing services that meet the...
Knowledge and practices with respect to malaria are aspects that need to be considered as part of effective malaria programs. We assessed and compared malaria practices and knowledge among those who had recently visited a health careprovider and those who had not. A matched, population-based case-control study was conducted among 338 women between 15 and 45 years of age and caretakers of children ? 9 years of age in Nouna, Burkina Faso. Little difference was found in the reported responses between the cases and controls, which indicates that recent visits to health careproviders may not have an effect on malaria risk or knowledge. Differences were noted in malaria practices, which could suggest that health careproviders are consulted only after home treatments fail. Therefore, programs and policies targeted to health careproviders aimed at improving the dissemination of information may be of some benefit. PMID:20211856
... Know how to get a copy of your medical records. Your new health careprovider will need them ... prescriptions refilled. I know where to find my medical records. I have discussed the use of tobacco, alcohol, ...
Inadequate attention to appropriate selection, distribution, and use of basic medicines in A.I.D. primary health care (PHC) activities in developing countries has often hindered implementation of PHC projects. This report provides general guidelines for p...
... Your Health CareProvider About Screening for Abdominal Aortic Aneurysm Partnership for HEALTH Ask your doctor for help ... next. You may need surgery. Is an Abdominal Aortic Aneurysm serious? y Most people who have aneurysms don’ ...
Background In recent decades, extensive resources have been invested to develop cellular, molecular and genomic technologies with clinical applications that span the continuum of cancercare. Methods In December 2006, the National Cancer Institute sponsored the first workshop to uniquely examine the state of health services research on cancer-related cellular, molecular and genomic technologies and identify challenges and priorities for expanding the evidence base on their effectiveness in routine care. Results This article summarizes the workshop outcomes, which included development of a comprehensive research agenda that incorporates health and safety endpoints, utilization patterns, patient and provider preferences, quality of care and access, disparities, economics and decision modeling, trends in cancer outcomes, and health-related quality of life among target populations. Conclusions Ultimately, the successful adoption of useful technologies will depend on understanding and influencing the patient, provider, health care system and societal factors that contribute to their uptake and effectiveness in ‘real-world’ settings.
Wideroff, Louise; Phillips, Kathryn A.; Randhawa, Gurvaneet; Ambs, Anita; Armstrong, Katrina; Bennett, Charles L.; Brown, Martin L.; Donaldson, Molla S.; Follen, Michele; Goldie, Sue J.; Hiatt, Robert A.; Khoury, Muin J.; Lewis, Graham; McLeod, Howard L.; Piper, Margaret; Powell, Isaac; Schrag, Deborah; Schulman, Kevin A.; Scott, Joan
Background This paper reports on work carried out to elicit information needs at a trans-disciplinary, nurse-managed health care clinic that serves a medically disadvantaged urban population. The trans-disciplinary model provides a “one-stop shop” for patients who can receive a wide range of services beyond traditional primary care. However, this model of health care presents knowledge sharing challenges because little is known about how data collected from the non-traditional services can be integrated into the traditional electronic medical record (EMR) and shared with other careproviders. There is also little known about how health information technology (HIT) can be used to support the workflow in such a practice. Objectives The objective of this case study was to identify the information needs of careproviders in order to inform the design of HIT to support knowledge sharing and distributed decision making. Methods A participatory design approach is presented as a successful technique to specify requirements for HIT applications that can support a trans-disciplinary model of care. Results Using this design approach, the researchers identified the information needs of careproviders working at the clinic and suggested HIT improvements to integrate non-traditional information into the EMR. These modifications allow knowledge sharing among careproviders and support better health decisions. Conclusions We have identified information needs of careproviders as they are relevant to the design of health information systems. As new technology is designed and integrated into various workflows it is clear that understanding information needs is crucial to acceptance of that technology.
BACKGROUND: There is growing concern certain not-for-profit hospitals are not providing enough uncompensated care to justify their tax exempt status. Our objective was to compare the amount of uncompensated careprovided by not-for-profit (NFP), for-profit (FP) and government owned hospitals. METHODS: We used 2005 state inpatient data (SID) for 10 states to identify patients hospitalized for three common conditions: acute
Peter Cram; Levent Bayman; Ioana Popescu; Mary S Vaughan-Sarrazin; Xueya Cai; Gary E Rosenthal
The Department of Veterans Affairs (VA) amends its regulations concerning the billing methodology for non-VA providers of home health services and hospice care. Because the newly applicable methodology cannot supersede rates for which VA has specifically contracted, this rulemaking will only affect home health and hospice careproviders who do not have existing negotiated contracts with VA. This rule also rescinds internal guidance documents that could be interpreted as conflicting with this final rule. PMID:23646376
The involvement of non-government organizations (NGOs) and support groups has helped strengthen public health services in addressing cancercare burden. Owing to the contribution of volunteers in cancercare, this article documents a qualitative study that examined challenges in attracting and retaining cancercare volunteers as part of the effort to develop a volunteer recruitment model. Data were collected through three focus group discussions involving 19 cancer support group members in Malaysia. Findings of the study revealed that mobility and locality appeared to be significant in Malaysian context, while the need for financial support and time flexibility are challenges faced by cancer support groups to attract and retain volunteers. The findings imply that cancercare initiatives can benefit from more local volunteers but at the same time these volunteers require flexibility and financial support to sustain their engagement. PMID:24083746
Aim of this study was to obtain a picture of the nature of the primary care pediatricians’ visits during a winter season. We investigated reasons for visits, diagnosis, and pattern of prescription in 284 children. The reason for visit was a planned visit in 54% of cases, a well-being examination in 26%, and an urgent visit for an acute problem in 20% of cases. Cough was the most common symptom reported (61%). The most common pediatricians’ diagnosis was flu-like syndrome (47%). No disease was found by pediatrician in 27% of children with a symptom reported by caregivers. Antibiotics were prescribed in 25% of children, the vast majority of which affected by viral respiratory infections. The unjustified access to physician’s visit may lead to a inappropriate prescription of drugs.
Palliative care is a treatment model that aims to relieve patient suffering and improve quality of life, and is essential for those living with chronic cancer. However, most palliative care referrals are made as a last resort when all other treatment options have failed. This article argues that social workers have an important role in early palliative care discussions because of their unique skill set. Techniques for early introduction of palliative care are addressed, as are ways for empowering patient advocacy. A case narrative of a young woman with chronic cancer is included as an example of the need for ongoing palliative care conversations. PMID:24405240
Background Ovarian cancer is the leading cause of death among women suffering from gynaecological malignancies in the Western world. Worldwide, approximately 200,000 women are diagnosed with the disease each year. This article deals with the health care seeking and symptom interpretation process among Danish women, who have a very high mortality rate. Methods The health seeking and symptom interpretation process was analysed via combining study methods. The material consisted of registry data dealing with the use of public health care and hospital services of Danish women, newly diagnosed with ovarian cancer. These results were combined with findings from semi-structured qualitative research interviews on women's bodily experiences with symptom development. Results A number of 663 Danish women with ovarian cancer attended 27 different kinds of primary health careproviders in a total of 14,009 visits during 2007. The women also had 6,214 contacts with various hospitals, and obtained 562 different diagnoses. From the main theme "Women's experiences with the onset of symptoms" three sub-themes were identified: "Bodily sensations", "From bodily sensation to symptom", and "Health seeking and treatment start". In all cases the General Practitioner represented the first contact to public health care, acting as gate-keeper to specialist and hospital referral. The women were major users of public health care throughout the diagnostic process and subsequent treatment. All women held personal knowledge concerning the onset of their symptoms. The early symptoms of ovarian cancer might be uncharacteristic and non-disease-specific when interpreted as personal experiences, but they had similarities when analysed together. Conclusions Diagnostic delay in ovarian cancer seems far from being exclusively a medical problem, as the delay proved to be influenced by organisational, cultural, and social factors, too. Initiatives facilitating the diagnostic process and research concerning the selection of individuals for further investigation are indicated. The way in which the women interpreted their symptoms was influenced by their personal experiences, their cultural, and their social background. This became crucial to the diagnostic process. These issues need to be explored through further research on women's experiences during the diagnostic process.
Introduction We examined the differential effects of the supply of physicians on care for breast cancer in Ontario and California. We then used criteria for optimum care for breast cancer to estimate the regional needs for the supply of physicians. Methods Ontario and California registries provided 951 and 984 instances of breast cancer diagnosed between 1998 and 2000 and followed until 2006. These cohorts were joined with the supply of county-level primary care physicians (PCPs) and specialists in cancercare and compared on care for breast cancer. Results Significant protective PCP thresholds (7.75 to ? 8.25 PCPs per 10 000 inhabitants) were observed for breast cancer diagnosis (odds ratio [OR] 1.62), receipt of adjuvant radiotherapy (OR 1.64) and 5-year survival (OR 1.87) in Ontario, but not in California. The number of physicians seemed adequate to optimize care for breast cancer across diverse places in California and in most Ontario locations. However, there was an estimated need for 550 more PCPs and 200 more obstetrician–gynecologists in Ontario’s rural and small urban areas. We estimated gross physician surpluses for Ontario’s 2 largest cities. Conclusion Policies are needed to functionally redistribute primary care and specialist physicians. Merely increasing the supply of physicians is unlikely to positively affect the health of Ontarians.
Gorey, Kevin M.; Luginaah, Isaac N.; Hamm, Caroline; Balagurusamy, Madhan; Holowaty, Eric J.
Despite interventions that have improved the overall health of the majority of Americans, racial and ethnic minorities have benefited less from these advances. Research has shown that multiple factors contribute to racial and ethnic disparities in health, health care, and cancercare. The Institute of Medicine Report, "Unequal Treatment" provides a detailed examination of racial/ethnic disparities in health care in the U.S., highlighting three clinical contributors--poor provider-patient communication, stereotyping in clinical decisionmaking, and patient mistrust. Although the findings and recommendations in "Unequal Treatment" are broad in scope, they provide a blueprint for how to address disparities in health care in general-as well as cancercare-and have direct implications for clinical practice, both nationally and internationally. We propose a patient-based approach to cross-cultural care as a model to improve communication with racial and ethnic minorities, and cross-cultural populations in general. We also highlight the importance of community based interventions, such as those that use health care navigators to promote cancer screening. If we hope to provide effective cancercare around the world, we must be attentive to the factors that impact minorities and vulnerable populations, and be prepared to address them. PMID:21952574
Aim: To determine the immediate influence of a validated patient information leaflet (PIL) on patient anxiety and intention to have a screen for oral cancer in primary care attenders. Participants: Patients (n=800) attending their primary health careprovider. Setting: Fourteen general practices (eight dental and six medical) in the northwest of England. Design: Randomised controlled trial with two arms: leaflets
Introduction Patients must have transportation to the treatment site before they can access appropriate cancercare. This paper describes factors associated with patients experiencing transportation-related barriers to accessing cancercare. Patients and Methods The CancerCare Assessment & Responsive Evaluation Studies (C-CARES) questionnaire was mailed to VA colorectal cancer (CRC) patients during fall 2009. Eligible patients were diagnosed at any VA facility in 2008, male, and alive at time of mailing. A total of 1,409 surveys were returned (approximately 67% response rate). To assess transportation barriers, patients were asked how often it was difficult to get transportation to or from treatment. Symptoms were assessed using validated PROMIS scales for fatigue, pain, and depression. Multivariate logistic regression was used to examine determinants of transportation barriers. Results A minority (19%) of respondents reported transportation barriers. Patients experiencing pain (OR 1.04, 95% CI 1.02, 1.06) had greater odds of transportation barriers than patients without this symptom. Patients who reported no primary social support (OR 6.13, 95% CI 3.10, 12.14) or non-spousal support (OR 2.00, 95% CI 1.40, 2.87) were more likely to experience transportation barriers than patients whose spouse provided social support. Discussion Patients with uncontrolled pain or less social support have greater odds of transportation barriers. The directional association between social support, symptoms, and transportation cannot be determined in this data. Conclusion Inquiring about accessible transportation should become a routine part of cancercare, particularly for patients with known risk factors.
Zullig, Leah L.; Jackson, George L.; Provenzale, Dawn; Griffin, Joan M.; Phelan, Sean; van Ryn, Michelle
Increasingly, cancer-related Web sites have been developed to provide information for patients. More needs to be done to understand the experience of men with cancer using the Internet. Heideggerian hermeneutics is the interpretive approach used to guide this study. Fifteen men with cancer who used the Internet were recruited through a prostate cancer support group and snowball sampling. Participants were individually interviewed and asked to tell stories of Internet use and practices. Transcribed interviews provided data for interpretive analysis. The overall constitutive pattern describing the men's experience is "cancer diagnosis as a problem to be solved." Five related themes included (1) seeking disease and treatments information from the Internet for decision making, to become comfortable with treatment plan; (2) organizing information to facilitate provider encounters and to monitor for reoccurrence; (3) evaluating Web information by credibility and usability with trust in the physician influencing the end decision point; (4) symptom management by knowing possibilities by hearing patient stories; and (5) navigating through the healthcare system politics and power. Men with cancer are incorporating Internet use into their cancer journey. They perceive changing provider-patient relationships when they participate in treatment decisions and monitor for reoccurrence. PMID:20975535
... cancer in children and adolescents. Most children's, or pediatric , cancer centers treat patients up to the age of ... as the Children's Cancer Group (CCG) and the Pediatric Oncology Group (POG), is a network of children's cancer ...
BACKGROUND: Despite the 1991 reforms of the health system in Zambia, mental health is still given low priority. This is evident from the fragmented manner in which mental health services are provided in the country and the limited budget allocations, with mental health services receiving 0.4% of the total health budget. Most of the mental health services provided are curative
Lonia Mwape; Alice Sikwese; Augustus Kapungwe; Jason Mwanza; Alan Flisher; Crick Lund; Sara Cooper
The preparation of paraprofessional providers of services to older adults is often a "back-burner" issue, even though most direct care of older clients and patients is provided by paraprofessionals. This community-academic project delivered gerontological training to 74 paraprofessional service providers and evaluated the impact of training on…
A series of seven focus groups of community mental health care consumers were conducted to identify the factors that contributed to consumer satisfaction. Three major themes were identified: bonding with providers, provider competence\\/knowledge, and cultural\\/religious competence. These findings are compared with findings from several healthcare satisfaction studies. Four focus groups with providers were also conducted to identify barriers to service
Karen Mason; Antonio Olmos-Gallo; Donald Bacon; Michael McQuilken; Aimee Henley; Steve Fisher
Background Continuity is a fundamental tenet of primary care, and highly valued by patients; it may also improve patient outcomes and lower cost of health care. It is thus important to investigate factors that predict higher continuity. However, to date, little is known about the factors that contribute to continuity. The purpose of this study was to analyse practice, provider and patient predictors of continuity of care in a large sample of primary care practices in Ontario, Canada. Another goal was to assess whether there was a difference in the continuity of careprovided by different models of primary care. Methods This study is part of the larger a cross-sectional study of 137 primary care practices, their providers and patients. Several performance measures were evaluated; this paper focuses on relational continuity. Four items from the Primary Care Assessment Tool were used to assess relational continuity from the patient’s perspective. Results Multilevel modeling revealed several patient factors that predicted continuity. Older patients and those with chronic disease reported higher continuity, while those who lived in rural areas, had higher education, poorer mental health status, no regular provider, and who were employed reported lower continuity. Providers with more years since graduation had higher patient-reported continuity. Several practice factors predicted lower continuity: number of MDs, nurses, opening on weekends, and having 24 hours a week or less on-call. Analyses that compared continuity across models showed that, in general, Health Service Organizations had better continuity than other models, even when adjusting for patient demographics. Conclusions Some patients with greater health needs experience greater continuity of care. However, the lower continuity reported by those with mental health issues and those who live in rural areas is concerning. Furthermore, our finding that smaller practices have higher continuity suggests that physicians and policy makers need to consider the fact that ‘bigger is not always necessarily better’.
The IMPACT Program seeks to improve access to prostate cancercare for low-income, uninsured men. The objective of the current\\u000a study was to compare the cost-effectiveness of four policy alternatives in treating this population. We analyzed the cost-effectiveness\\u000a of four policy alternatives for providingcare to low-income, uninsured men with prostate cancer: (1) IMPACT as originally\\u000a envisioned, (2) a version
Jonathan Bergman; Susan Logan; Arlene Fink; David A. Ganz; Mark A. Peterson; Mark S. Litwin
As the volume of data that is electronically available promliferates, the health-care industry is identifying better ways to use this data for patient care. Ideally, these data are collected in real time, can support point-of-care clinical decisions, and, by providing instantaneous quality metrics, can create the opportunities to improve clinical practice as the patient is being cared for. The business-world technology supporting these activities is referred to as business intelligence, which offers competitive advantage, increased quality, and operational efficiencies. The health-care industry is plagued by many challenges that have made it a latecomer to business intelligence and data-mining technology, including delayed adoption of electronic medical records, poor integration between information systems, a lack of uniform technical standards, poor interoperability between complex devices, and the mandate to rigorously protect patient privacy. Efforts at developing a health care equivalent of business intelligence (which we will refer to as clinical intelligence) remains in its infancy. Until basic technology infrastructure and mature clinical applications are developed and implemented throughout the health-care system, data aggregation and interpretation cannot effectively progress. The need for this approach in health care is undisputed. As regional and national health information networks emerge, we need to develop cost-effective systems that reduce time and effort spent documenting health-care data while increasing the application of knowledge derived from that data. PMID:20659837
McShea, Michael; Holl, Randy; Badawi, Omar; Riker, Richard R; Silfen, Eric
Background Cultural and language discordance between patients and providers constitutes a significant challenge to provision of quality healthcare. This study aims to evaluate minority patients’ discharge from hospital to community care, specifically examining the relationship between patient–provider language concordance and the quality of transitional care. Methods This was a multi-method prospective study of care transitions of 92 patients: native Hebrew, Russian or Arabic speakers, with a pre-discharge questionnaire and structured observations examining discharge preparation from a large Israeli teaching hospital. Two weeks post-discharge patients were surveyed by phone, on the transition from hospital to community care (the Care Transition Measure (CTM-15, 0–100 scale)) and on the primary-care post-discharge visit. Results Overall, ratings on the CTM indicated fair quality of the transition process (scores of 51.8 to 58.8). Patient–provider language concordance was present in 49% of minority patients’ discharge briefings. Language concordance was associated with higher CTM scores among minority groups (64.1 in language-concordant versus 49.8 in non-language-concordant discharges, P <0.001). Other aspects significantly associated with CTM scores: extent of discharge explanations (P <0.05), quality of discharge briefing (P <0.001), and post-discharge explanations by the primary care physician (P <0.01). Conclusion Language-concordant care, coupled with extensive discharge briefings and post-discharge explanations for ongoing care, are important contributors to the quality of care transitions of ethnic minority patients.
Background: Adjustment for stage at diagnosis markedly reduces USA versus European colorectal cancer survival differences and a screening bias was therefore suspected. Moreover, little is known about colorectal cancer screening habits in European primary care and the history of guidelines implementation. The purpose of the study was to index the overall colorectal cancer screening attitudes of European physicians involved in
CANCERCARE IN THE UNITED STATES: WHAT'S RIGHT, WHAT'S WRONG? ENSURING THE QUALITY OF CANCERCARE Robert Hiatt, M.D., Ph.D., Deputy Director of the Division of Cancer Control and Population Sciences National Cancer Institute National Institutes
Multidisciplinary team (MDT) meetings are becoming the model of care for cancer patients worldwide. While MDTs have improved the quality of cancercare, the meetings impose substantial time pressure on the members, who generally attend several such MDTs. We describe Lung Cancer Assistant (LCA), a clinical decision support (CDS) prototype designed to assist the experts in the treatment selection decisions in the lung cancer MDTs. A novel feature of LCA is its ability to provide rule-based and probabilistic decision support within a single platform. The guideline-based CDS is based on clinical guideline rules, while the probabilistic CDS is based on a Bayesian network trained on the English Lung Cancer Audit Database (LUCADA). We assess rule-based and probabilistic recommendations based on their concordances with the treatments recorded in LUCADA. Our results reveal that the guideline rule-based recommendations perform well in simulating the recorded treatments with exact and partial concordance rates of 0.57 and 0.79, respectively. On the other hand, the exact and partial concordance rates achieved with probabilistic results are relatively poorer with 0.27 and 0.76. However, probabilistic decision support fulfils a complementary role in providing accurate survival estimations. Compared to recorded treatments, both CDS approaches promote higher resection rates and multimodality treatments. PMID:24990290
Sesen, M Berkan; Peake, Michael D; Banares-Alcantara, Rene; Tse, Donald; Kadir, Timor; Stanley, Roz; Gleeson, Fergus; Brady, Michael
Barriers in seeking access to conventional health care services continue to be a problem in the United States, especially among recent racial and ethnic immigrants who tend to be least able to afford adequate health insurance coverage. Ethnic immigrants sometimes seek out traditional healers as unconventional providers of health care services to overcome barriers in accessing the conventional health care delivery system. The purpose of this work is to provide insight into the practices of Picuristes or Haitian "lay injectionists" in their role as alternative, unconventional providers of health care services among Haitian immigrants in South Florida. Based on in-depth interviews with 10 picuristes who were identified through venue and snowball sampling and who volunteered to participate in a larger exploratory study that examined various aspects of picuriste practices, findings revealed benefits and risks of seeking health care services from these traditional practitioners. Among the benefits reported to their services were greater accessibility, affordability, convenience, and cultural compatibility. Risks observed from analysis of picuriste interviews included the lack of formal medical training for picuristes, their nonadherence to established standards for safe injections and their potential to expose clients and the community to contaminated needles, syringes, and other biohazardous waste materials. Insight was also gained into how picuristes learned to practice their trade and to incorporate Haitian cultural beliefs regarding the relationship between clients and healers. Given the continuation of barriers to health care among ethnic immigrants, implications for conventional heath care practice and social policy are also discussed. PMID:21932978
Rahill, Guitele J; Dawkins, Marvin P; De La Rosa, Mario
Objective This paper describes a community-based intervention to provide a dental home for women covered by Medicaid in Klamath County, Oregon. In 2001, 8.8% of pregnant women served by Medicaid in Oregon received care. Methods Pregnant women received home/WIC visits and were assigned a dental home under a dental managed care program (DCO). All initial care was provided at the Oregon Institute of Technology Dental Hygiene Clinic under the contract with the DCO. Emergency, preventive and restorative care was provided. Result Between February 2004 and January 2006, 503 pregnant women were identified: 421 women were contactable. Of these, 339 received home visits (339/421, 80.5%) and 235 received care (235/339, 69.3%). Overall, 55.8% of eligible women received care (235/421). Most who did not have a visit either moved or were not the caretaker of the baby. The missed appointment rate was 9%. Conclusion A community health partnership led to a successful and sustainable model extending care to pregnant women.
Milgrom, Peter; Ludwig, Sharity; Mike Shirtcliff, R.; Smolen, Darlene; Sutherland, Marilynn; Gates, Patricia A.; Weinstein, Philip
PCCOs should take inventory of the information demands in the critical areas of quality, resource, and outcomes management, and standardize the data elements and definitions as the enterprise data model. The focus must be on internal and external reporting requirements as, ultimately, the data model must expedite clinical practice improvement initiatives. The Informational Processing Architecture utilizes the data warehouse for enterprise decision support to derive clinical/business rules and the operational data store/applications for clinical decision support to deploy those same rules at the point of care. As a result, clinical and financial systems should be tightly linked, associating outcomes, process, and cost. In designing these systems, the Systems Development Life Cycle methodology has the advantages of documented deliverables and a well proven methodology for outlining requirements put forth in an RFP, which is indispensable for vendor evaluation and selection. Employing these techniques ensures a user driven process that has the best chance of implementing the complex requirements of PCCOs. PMID:10163171
Objective To identify factors associated with perceptions of care coordination in a diverse sample of breast cancer patients. Methods Breast cancer patients reported to the metropolitan SEER registries of Detroit or Los Angeles from 6/05 to 2/07 were surveyed after diagnosis (N=2268, RR= 72.4%). Outcomes were two dichotomous measures reflecting patient appraisal of care coordination during their treatment experience. Primary independent variables were race/ethnicity (white, African American, Latina-high acculturated, Latina-low acculturated) and health literacy (low, moderate, high). Logistic regression was used to evaluate factors associated with both measures of care coordination. Results 2,148 subjects were included in the analytic dataset. 16.4% of women perceived low care coordination and 12.5% reported low satisfaction. Race/ethnicity was not significantly associated with care coordination. Women with low subjective health literacy were 3–4 times as likely as those with high health literacy to perceive low care coordination and low satisfaction with care coordination (OR=3.88; 95% CI: 2.78–5.41; OR=3.19 95% CI:2.25–4.52, respectively). Conclusions Many breast cancer patients positively appraised their care coordination, but patients with low health literacy perceived low care coordination. Practice Implications Providers should be aware of health literacy deficits that may contribute to their patients’ attitudes towards their breast cancercare coordination.
Hawley, Sarah T.; Janz, Nancy K.; Lillie, Sarah E.; Friese, Christopher R.; Griggs, Jennifer J.; Graff, John J.; Hamilton, Ann S.; Jain, Sarika; Katz, Steven J.
Background Bladder cancer is among the most prevalent and expensive to treat cancers in the United States. In the absence of high-level evidence to guide the optimal management of bladder cancer, urologists may vary widely in how aggressively they treat early-stage disease. We examined associations between initial treatment intensity and subsequent outcomes. Methods We used the Surveillance, Epidemiology, and End Results–Medicare database to identify patients who were diagnosed with early-stage bladder cancer from January 1, 1992, through December 31, 2002 (n = 20 713), and the physician primarily responsible for providingcare to each patient (n = 940). We ranked the providers according to the intensity of treatment they delivered to their patients (as measured by their average bladder cancer expenditures reported to Medicare in the first 2 years after a diagnosis) and then grouped them into quartiles that contained approximately equal numbers of patients. We assessed associations between treatment intensity and outcomes, including survival through December 31, 2005, and the need for subsequent major interventions by using Cox proportional hazards models. All statistical tests were two-sided. Results The average Medicare expenditure per patient for providers in the highest quartile of treatment intensity was more than twice that for providers in the lowest quartile of treatment intensity ($7131 vs $2830, respectively). High–treatment intensity providers more commonly performed endoscopic surveillance and used more intravesical therapy and imaging studies than low–treatment intensity providers. However, the intensity of initial treatment was not associated with a lower risk of mortality (adjusted hazard ratio of death from any cause for patients of low– vs high–treatment intensity providers = 1.03, 95% confidence interval 0.97 to 1.09). Initial intensive management did not obviate the need for later interventions. In fact, a higher proportion of patients treated by high–treatment intensity providers than by low–treatment intensity providers subsequently underwent a major medical intervention (11.0% vs 6.4%, P = .02). Conclusions Providers vary widely in how aggressively they manage early-stage bladder cancer. Patients treated by high–treatment intensity providers do not appear to benefit in terms of survival or in avoidance of subsequent major medical interventions.
Ye, Zaojun; Dunn, Rodney L.; Montie, James E.; Birkmeyer, John D.
Integrated behavioral health and primary care is emerging as a superior means by which to address the needs of the whole person, but we know neither the extent nor the distribution of integration. Using the Centers for Medicare and Medicaid Services' National Plan and Provider Enumeration System (NPPES) Downloadable File, this study reports where colocation exists for (a) primary careproviders and any behavioral health provider and (b) primary careproviders and psychologists specifically. The NPPES database offers new insights into where opportunities are limited for integration due to workforce shortages or nonproximity of providers and where possibilities exist for colocation, a prerequisite for integration. (PsycINFO Database Record (c) 2014 APA, all rights reserved). PMID:24820692
Miller, Benjamin F; Petterson, Stephen; Burke, Bridget Teevan; Phillips, Robert L; Green, Larry A
Primary careproviders frequently recommend, administer, or prescribe health care services that are unlikely to benefit their patients. Yet little is known about how to reduce provider overuse behavior. In the absence of a theoretically grounded causal framework, it is difficult to predict the contexts under which different types of interventions to reduce provider overuse will succeed and under which they will fail. In this article, we present a framework based on the theory of planned behavior that is designed to guide overuse research and intervention development. We describe categories of primary careprovider beliefs that lead to the formation of intentions to assess the appropriateness of services, and propose factors that may affect whether the presence of assessment intentions results in an appropriate recommendation. Interventions that have been commonly used to address provider overuse behavior are reviewed within the context of the framework. PMID:23916984
Powell, Adam A; Bloomfield, Hanna E; Burgess, Diana J; Wilt, Timothy J; Partin, Melissa R
BACKGROUND: Health care for cancer patients is primarily shaped by health care professionals. This raises the question to what extent health care professionals are aware of patients' preferences, needs and values. The aim of this study was to explore to what extent there is concordance between patients' preferences in cancercare and patients' preferences as estimated by health care professionals.
Hester Wessels; Alexander de Graeff; Klaske Wynia; Miriam de Heus; Cas LJJ Kruitwagen; Saskia CCM Teunissen; Emile E Voest
In 2006, CDC recommended HIV screening as part of routine medical care for all persons aged 13–64 years. We examined adherence to the recommendations among a sample of HIV careproviders in the US to determine if known providers of HIV care are offering routine HIV testing in outpatient settings. Data were from the CDC's Medical Monitoring Project Provider Survey, administered to physicians, nurse practitioners and physician assistants from June-September 2009. We assessed bivariate associations between testing behaviors and provider and practice characteristics and used multivariate regression to determine factors associated with offering HIV screening to all patients aged 13–64 years. Sixty percent of providers reported offering HIV screening to all patients 13 to 64 years of age. Being a nurse practitioner (aOR?=?5.6, 95% CI?=?2.6–11.9) compared to physician, age<39 (aOR?=?1.9, 95% CI?=?1.0–3.5) or 39–49 (aOR?=?2.1, 95% CI?=?1.4–3.3) compared with ?50 years, and black race (aOR?=?2.6, 95% CI?=?1.2–6.0) compared with white race was associated with offering testing to all patients. Providers with low (aOR?=?0.2, 95% CI?=?0.1–0.3) or medium (aOR?=?0.4, 95% CI?=?0.2–0.6) HIV-infected patient loads were less likely to offer HIV testing to all patients compared with providers with high patient loads. Many providers of HIV care are still conducting risk-based rather than routine testing. We found that provider profession, age, race, and HIV-infected patient load were associated with offering HIV testing. Health careproviders should use patient encounters as an opportunity to offer routine HIV testing to patients as outlined in CDC's revised recommendations for HIV testing in health care settings.
McNaghten, A. D.; Valverde, Eduardo E.; Blair, Janet M.; Johnson, Christopher H.; Freedman, Mark S.; Sullivan, Patrick S.
Primary care is an optimal place to target modifiable health behavior problems that are linked to increased risk for mortality. The Veterans Administration (VA) has recognized the importance of coordinated, patient-centered care that increases access to health care services and has recently initiated efforts to implement Patient Aligned Care Teams within the primary care setting. To help support this initiative, administrative leaders at a large VA Health Care organization implemented a training program to teach all primary care staff motivational interviewing (MI) across its local facilities. Guided by the Consolidated Framework for Implementation Research, we examined the characteristics of providers working within this setting in an attempt to better understand the specific training needs of this group with the goal of optimizing the adoption of MI-related skills. Our findings show that providers vary on perspectives of lifestyle counseling, time commitment pressure, job-related burnout, and self-efficacy, which have important implication for the design and implementation of future trainings in MI and other evidence-based therapies. PMID:24073081
Midboe, Amanda M; Cucciare, Michael A; Trafton, Jodie A; Ketroser, Nicole; Chardos, John F
The objective of this study was to assess the role of provider coordination on nurse manager and physician perceptions of care quality, while controlling for organizational factors. Findings indicated that nurse-nurse coordination was positively associated with nurse manager perceptions of care quality; neither physician-physician nor physician-nurse coordination was associated with physician perceptions. Organizational factors associated with positive perceptions of care quality included facility support of education for nurses and physicians, and the use of multidisciplinary rounding. PMID:24509244
McIntosh, Nathalie; Burgess, James F; Meterko, Mark; Restuccia, Joseph D; Alt-White, Anna C; Kaboli, Peter; Charns, Martin
The American Cancer Society's Health Insurance Assistance Service provides callers to its National Cancer Information Center with detailed knowledge to help them access or maintain health insurance coverage for which they might be eligible. Demographic data from April 2009 to June 2011 show that 76 % were uninsured and between the ages of 40-60; 65 % were Caucasian, 17 % African American, and 12% Hispanic; and monthly incomes were $1,999 or less. Current trends indicate that callers are similar to those identified in various health care reform publications: callers are unable to afford co-pays; facilities are requesting cash upfront; callers report loss of coverage, less adequate or less affordable coverage from employers; large out-of-pocket expense or high deductibles are needed; and modification of the CDC's Breast and Cervical Screening Program's eligibility guidelines create challenges. Six lessons that have been learned while initiating and managing this program are presented. PMID:23371058
Background: In the recent years, advances in medical technologies for end stage cancer patients’ care have affected the end-of-life decision-making in clinical practice and exposed oncologists to serious ethical dilemmas. But little is known about oncologists’ viewpoints in our country regarding their ethical problems in this mention. We aimed to clarify the ethical dilemmas which Iranian oncologists may face in our health care setting and to determine factors influencing decision-making process. Methods: In this qualitative study, a phenomenological approach was used. We interviewed 8 cancer specialists in teaching hospitals in Iran and used content analysis to identify codes and categorize themes in the data. Results: During the process of analysis, three main themes emerged about ethical dilemmas in end of life care for advanced cancer patients: illness factors, socio-cultural context and patient-physician relationship. Cancer specialists identified ethical problems on several main issues, the most important of which were telling the truth in Iranian cultural context, uncertainty in end stage definition, multidisciplinary team working and cost consideration in Iranian health care system. Conclusion: Health care and insurance system in Iran face to end of life care challenges; therefore, health careproviders and policy makers need to allocate appropriate resources and programs to improve quality of care in terminal stages. Appropriate physicians’ communication skills training, multidisciplinary team working and supplementary insurance services that provide essential health care can improve the quality of care of patients with end stages of cancer. The findings of this study can help us to provide ethical policies for decision-making in end-of-life care.
This paper analyzes the relationship between the financial health and organizational form of private health careproviders in Brazil. It also examines the major determinants of customer satisfaction associated with the provider's organizational form. An adjusted Altman's z-score is used as an indicator of financial health. A proxy variable based on customer complaints filed at the Brazilian National Agency for Supplementary Health is used as an indicator for customer satisfaction. The study uses a sample of 270 private health careproviders and their operations over the period 2003-2005. Panel data analysis includes control variables related to market, operations, and management. Principal results indicate that: (1) private health careproviders benefit from economies of scale; (2) self-funded health plans have better financial health; (3) spending on marketing does not have a significant impact on customer satisfaction in Brazil; (4) weak empirical evidence exists showing that good financial performance enhances customer's satisfaction. PMID:22124495
Schiozer, Rafael Felipe; Saito, Cristiana Checchia; Saito, Richard
A basic life support system (BLSS) includes a processing element and an output element, such as a display screen or an audio output element, for providing an individual with real-time instructions on providing emergency medical care to a patient until paramedics or other healthcare professionals arrive to take over care for the patient. The instructions may be provided as graphics, including animations, as text, audibly, or as a combination of visible and audible elements. The BLSS may be configured for providing emergency medical care to individuals who have suffered from ventricular fibrillation. Accordingly, the BLSS may also include a defibrillation apparatus, an air or oxygen supply, a respiratory interface, one or more sensors, or a combination thereof.
Worldwide, health careproviders use strikes and job actions to influence policy. For health careproviders, especially physicians, strikes create an ethical tension between an obligation to care for current patients (e.g., to providecare and avoid abandonment) and an obligation to better care for future patients by seeking system improvements (e.g., improvements in safety, to access, and in the composition and strength of the health care workforce). This tension is further intensified when the potential benefit of a strike involves professional self-interest and the potential risk involves patient harm or death. By definition, trainees are still forming their professional identities and values, including their opinions on fair wages, health policy, employee benefits, professionalism, and strikes. In this article, the authors explore these ethical tensions, beginning with a discussion of reactions to a potential 2005 nursing strike at the University of California, Davis, Medical Center. The authors then propose a conceptual model describing factors that may influence health careproviders' decisions to strike (including personal ethics, personal agency, and strike-related context). In particular, the authors explore the relationship between training level and attitudes toward taking a job action, such as going on strike. Because trainees' attitudes toward strikes continue to evolve during training, the authors maintain that open discussion around the ethics of health care professionals' strikes and other methods of conflict resolution should be included in medical education to enhance professionalism and systems-based practice training. The authors include sample case vignettes to help initiate these important discussions. PMID:21436671
Li, Su-Ting T; Srinivasan, Malathi; Der-Martirosian, Claudia; Kravitz, Richard L; Wilkes, Michael S
PURPOSE: To describe a preliminary investigation of a model of naltrexone therapy and counselling for use by primary careproviders and evaluate its impact on drinking behaviors in a cohort of alcohol-dependent subjects.PATIENTS AND METHODS: The subjects enrolled in this study were 29 alcohol-dependent individuals. They were managed within a primary care treatment model located at a university-affiliated substance research
Patrick G O’Connor; Conor K Farren; Bruce J Rounsaville; Stephanie S O’Malley
Climate change has the potential to influence the earth's biological systems, however, its effects on human health are not well defined. Developing nations with limited resources are expected to face a host of health effects due to climate change, including vector-borne and water-borne diseases such as malaria, cholera, and dengue. This article reviews common and prevalent infectious diseases in India, their links to climate change, and how health careproviders might discuss preventive health care strategies with their patients.
Partnership between health careproviders and patients is important for controlling illness. A limited number of studies show how to assess health professionals' communication and partnering behavior. The relationship between these aspects of professional behavior and enhanced management of disease by patients has received little empirical study. The research reported here developed a Health CareProviders' Teaching and Communication Behavior (TCB) scale for assessing the teaching and communication behavior of clinicians treating patients with asthma. Such a tool is needed for research related to provider-patient relationships and for evaluation of professionals' performance. PMID:9079582
Clark, N M; Gong, M; Schork, M A; Maiman, L A; Evans, D; Hurwitz, M E; Roloff, D; Mellins, R B
Aims\\/hypothesis We assessed country-level and individual-level patterns in patient and provider perceptions of diabetes care.\\u000a \\u000a \\u000a \\u000a Methods The study used a cross-sectional design with face-to-face or telephone interviews of diabetic patients and healthcare providers\\u000a in 13 countries from Asia, Australia, Europe and North America. Participants were randomly selected adults with type 1 or\\u000a type 2 diabetes (n=5,104), and randomly selected diabetes-careproviders, including
M. Peyrot; R. R. Rubin; T. Lauritzen; S. E. Skovlund; F. J. Snoek; D. R. Matthews; R. Landgraf
Primary careproviders were surveyed to determine how prepared they feel to address nonsuicidal self-injury (NSSI) among adolescents, their interest in training on NSSI, and factors associated with routinely asking about NSSI when providing health supervision. Participants included family medicine physicians ("n" = 260), pediatricians…
Taliaferro, Lindsay A.; Muehlenkamp, Jennifer J.; Hetler, Joel; Edwall, Glenace; Wright, Catherine; Edwards, Anne; Borowsky, Iris W.
Noting the rapid changes occurring in the world of infectious diseases, this book provides updated information for careproviders, educators, and parents on the increasingly complex issues of childhood infection. The book is organized into two parts. The first part discusses general considerations for group settings. Chapter 1 introduces the…
This study investigated 57 family child caregivers longitudinally to identify turnover precursors. Providers most likely to leave had more education, less training, and more stress than providers who stayed. Training and caring for one's own children indirectly affected turnover through job stress. Job satisfaction was unrelated to turnover. Job…
President Barack Obama is wasting no time in unfolding his plan to provide health coverage for all Americans. He started in February by signing legislation to reinstate the State Children's Health Insurance Program, which expands eligibility criteria to provide 4 million more children access to health care. This first step is one of many needed to…
Time to Talk Tips Time To Talk With Your Health CareProviders: 4 Tips To Start the Conversation When patients tell their providers about their ... About Complementary Health Approaches for Quitting Smoking More Time To Talk Tip Sheets Home Home Page Contact ...
Because children under age 5 are susceptible to food-borne illnesses and children in diapers present special sanitation and health problems, food safety and sanitation are emerging as important issues for child careproviders. This booklet is designed to give providers and parents a quick and easy reference for food safety and sanitation. The…
Food Safety and Inspection Service (USDA), Washington, DC.
The purpose of this investigation was to understand the varied health careprovider responses to traumas by identifying perceptions of control and self-efficacy, appraisal styles, and postevent coping strategies in active duty military nurses and physicians deployed to combat/terrorist regions. Twenty purposively sampled military health careproviders completed a descriptive questionnaire, the Posttraumatic Stress Disorder Checklist, the General Self-Efficacy Scale, and a recorded semistructured interview that was later transcribed and content analyzed. Cognitive-behavioral determinants of healthy response to trauma were used to frame this descriptive interpretive study and to assist with developing a model for healthy adaptation in trauma-exposed health careproviders. Participants felt they had the greatest control over their health careprovider role in theater, and most expressed a belief that a sense of control and a sense of purpose were important to their coping. All used some form of social support to cope and many found calming activities that allowed for self-reflection to be helpful. Results from this analysis can be used to inform interventions and promote postevent coping behaviors that increase social support, strengthen important bonds, and enhance involvement in activities that elicit positive emotions. Health careproviders experienced positive outcomes despite considerable traumatic exposure by using coping strategies that map closely to several principles of psychological first aid. This suggests a need to train all medical personnel in these concepts as they appear helpful in mitigating responses to the stress of combat-related exposures. PMID:23855421
Gibbons, Susanne W; Shafer, Michaela; Aramanda, Larry; Hickling, Edward J; Benedek, David M
The progressive rise of ED visits globally, and insufficient numbers of emergency physicians, has resulted in the use of mid-level providers as adjuncts for the provision of emergency care, especially in the US and Canada. Military medics, midwives, aeromedical paramedics, EMT-Ps, flight nurses, forensic nurses, sexual assault nurse examiner nurses - are some examples of well-established mid-level provider professionals who achieve their clinical credentials through accredited training programmes and formal certification. In emergency medicine, however, mid-level providers are trained for general care, and typically acquire emergency medicine skills through on-the-job experience. There are very few training programmes for NPs and PAs in emergency care. The manpower gap for physicians in general, and emergency physicians specifically, will not be eliminated in the reasonable future. Mid-level providers - ENTs, paramedics, NPs, PAs - are an excellent addition to the emergency medicine workforce. However, the specialty of emergency medicine developed because specific and focused training was needed for physicians to practice safe and qualify emergency care. This same principle applies to mid-level providers. Emergency Medicine needs to develop a vision and a plan to train emergency medicine specialist NPs and PAs, and explore other innovations to expand our emergency care workforce. PMID:25065770
Compassion is a language that is understood across cultures, religions, and nations. Being compassionate and empathetic is a basic responsibility of health careproviders responding to disasters. Compassion and empathy cannot be operationalized unless providers show culturally competent, ethically right, and spiritually caring behavior. In addition to being accepting of cultures other than their own, providers must read literature and familiarize themselves with the predominant cultures of the affected population. Ethically right decision making is essentially an act of balancing the risks and benefits to the entire society. Spiritual care is an important dimension of total health, and therefore recognition and resolution of the spiritual needs of disaster victims is an essential role of health careproviders. Disaster management is teamwork and therefore requires that health careproviders draw on the expertise and support of other team members; coordinating efforts with local religious, social governmental organizations, and NGOs to deal with the intangible effects of the cultural and spiritual impact of a disaster and to prevent further demoralization of the affected community is imperative. Disasters occur, and the only thing that can ameliorate their devastating effects is to improve disaster preparedness and respond collectively and courageously to every catastrophic event. PMID:21095554
... cancer -- the biggest cancer killer in the United States. The goal is to make it routine to ... cancer, from 14 medical centers across the United States. Of those patients, about one-third were tested ...
Oncology Overviews are a service of the International Cancer Research Data Bank (ICRDB) Program of the National Cancer Institute, intended to facilitate and promote the exchange of information between cancer scientists by keeping them aware of literature ...
Lung cancer patients face poor survival and experience co-occurring chronic physical and psychological symptoms. These symptoms can result in significant burden, impaired physical and social function and poor quality of life. This paper provides a review of evidence based interventions that support best practice supportive and palliative care for patients with lung cancer. Specifically, interventions to manage dyspnoea, one of the most common symptoms experienced by this group, are discussed to illustrate the emerging evidence base in the field. The evidence base for the pharmacological management of dyspnoea report systemic opioids have the best available evidence to support their use. In particular, the evidence strongly supports systemic morphine preferably initiated and continued as a once daily sustained release preparation. Evidence supporting the use of a range of other adjunctive non-pharmacological interventions in managing the symptom is also emerging. Interventions to improve breathing efficiency that have been reported to be effective include pursed lip breathing, diaphragmatic breathing, positioning and pacing techniques. Psychosocial interventions seeking to reduce anxiety and distress can also improve the management of breathlessness although further studies are needed. In addition, evidence reviews have concluded that case management approaches and nurse led follow-up programs are effective in reducing breathlessness and psychological distress, providing a useful model for supporting implementation of evidence based symptom management strategies. Optimal outcomes from supportive and palliative care interventions thus require a multi-level approach, involving interventions at the patient, health professional and health service level.
Schofield, Penelope; Zhao, Isabella; Currow, David
Abstract Retention in HIV treatment may reduce morbidity and mortality, as well as slow the epidemic. Myriad barriers to retention include stigma, homophobia, structural barriers, transportation, and insurance. The purpose of this study was to evaluate patient perceptions of provider attitudes among HIV-infected persons within a state-wide public hospital system in Louisiana. A convenience sample of patients attending HIV clinics throughout the state participated in an anonymous interview. Factors associated with negative perceptions of care were evaluated in conjunction with a validated stigma measure. Factors associated with having a delayed entry into or break in care were evaluated in conjunction with perceived stigma. Between 2/1/09 and 7/31/11, 479 participants were interviewed and had sufficient data available, of whom 53.4% were male, 79.3% were African American, and 29.4% reported a break or delayed entry into HIV care of >1 year. A break in care was associated with perceiving that the doctor or health professionals do not listen carefully most or all of the time (p<0.01), having an elevated stigma score (p<0.05), and indicating that providers dislike caring for HIV-infected people (p<0.01). Women were more likely to have an elevated stigma score than men (p<0.01), as were participants over 30 (p<0.01); those with a gay/bisexual orientation (p<0.05) were less likely to have an elevated stigma score. Those with a break in care were less likely to have Medicaid (p<0.05). Providers play a key role in the retention of HIV-infected persons in care and are critical to improving outcomes and slowing the epidemic. Development of novel approaches to reduce stigma are imperative in improving retention.
Approximately 30% of patients participating in the national antiretroviral therapy (ART) program in Argentina fail to achieve an undetectable viral load, and approximately 25% are not retained in care. This qualitative study was designed to explore and identify factors associated with engagement and retention in public and private health care in Buenos Aires, Argentina. Qualitative data from key informants (n = 12) and focus groups (n = 4 groups) of patients and providers from private and public HIV treatment facilities were recorded and transcribed. Predetermined and arising themes related to adherence, engagement, and retention in care were coded and analyzed using qualitative data analysis software. Reasons identified for patients’ lack of adherence or engagement in care differed between patients and providers, and patients attributed limitations to low self-efficacy, fear and concerns about HIV, and lack of provider involvement in treatment. In contrast, providers viewed themselves as decision-makers in patient care and patients as responsible for their own nonadherence due to lack of commitment to their own health or due to medication side effects. Patients reported health care system limitations and HIV concerns contributed to a lack of engagement, and providers identified limited HIV literacy and stigma as additional problems. Both agreed that chronic illness and substance addiction impacted adherence and retention, and agreed on the importance of trust, honesty, and communication in the patient–provider relationship. Results support the incorporation of system-, provider-, and patient-focused components into interventions to facilitate patient engagement, adherence, and retention in public and private settings in Argentina.
Objective To identify primary careproviders’ (PCPs) perceived barriers to educating patients about chronic kidney disease (CKD) during routine clinical visits. Methods We conducted three focus groups of eighteen PCPs in Baltimore, Maryland (MD), USA. Focus groups began with the presentation of a hypothetical case of a patient with CKD, followed by open-ended questions to assess providers’ perceived barriers to delivering education about CKD. Groups were audiotaped, transcribed, and coded independently by two investigators who identified major themes. Results PCPs reported on several patient, provider and system level barriers contributing to poor education about CKD in primary care that were both common and unique to barriers previously reported in educating patients regarding other chronic diseases. Conclusions Interventions designed to address barriers to CKD education identified by PCPs could improve the delivery of education about CKD in primary care settings.
Greer, Raquel C.; Crews, Deidra C.; Boulware, L. Ebony
A significant number of asylum seekers who largely survived torture live in the United States. Asylum seekers have complex social and medical problems with significant barriers to health care access. When evaluating and providingcare for survivors, health providers face important challenges regarding medical ethics and professional codes. We review ethical concerns in regard to accountability, the patient-physician relationship, and moral responsibilities to offer health care irrespective of patient legal status; competing professional responsibility toward society and the judiciary system; concerns about the consistency of asylum seekers' claims; ethical concerns surrounding involving trainees and researching within the evaluation setting; and the implication of broader societal views towards rights and social justice. We discuss contributing factors, including inadequate and insufficient provider training, varying and inadequate institutional commitment, asylum seekers' significant medical and social problems, and the broader health and social system issues. We review existing resources to address these concerns and offer suggestions. PMID:23767428
The Radiation Oncology Community Outreach Group (ROCOG) and Neighborhood CancerCare Cooperative (NCCC) were funded by the National Cancer Institute Radiation Research Program Cancer Disparities Research Partnership program in September 2003. ROCOG/NCCC provides customized, community hospital-based initiatives intended to help close the cancer disparities gap. In our two preceding articles in this issue, we have explored contextual and organizational development, described infrastructure and component programs, and outlined early evaluation strategies. This article will conclude the series of publications describing our early development by evaluating the formative implementation phase of the project. Our first 12 months were initially evaluated through a survey designed to assess staff and key stakeholders' perception of progress. An assessment of the level of completion of key project tasks was conducted 6 months after the survey. This combination has allowed ROCOG/NCCC to determine areas of success and also illustrate those in need of improvement. Our evaluation strategy can also serve as an efficient and inexpensive model for other similar community-based start-up programs to replicate. PMID:19517299
Morgenlander, Keith H; Tsai, Hsin-Ling; Schenken, Larry L; Heron, Dwight E; Klewien, Barbara; Lin, Chyongchiou J; Schwaderer, Karen; McNelly, Sibyl L
Purpose: The evidence-based use of resources for cancercare at end of life (EOL) has the potential to relieve suffering, reduce health care costs, and extend life. Internal benchmarks need to be established within communities to achieve these goals. The purpose for this study was to evaluate data within our community to determine our EOL cancer practices. Methods: A random sample of 390 patients was obtained from the 942 cancer deaths in Wicomico County, Maryland, for calendar years 2004 to 2008. General demographic, clinical event, and survival data were obtained from that sample using cancer registry and hospice databases as well as manual medical record reviews. In addition, the intensity of EOL cancercare was assessed using previously proposed indicator benchmarks. The significance of potential relationships between variables was explored using ?2 analyses. Results: Mean age at death was 70 years; 52% of patients were male; 34% died as a result of lung cancer. Median survival from diagnosis to death was 8.4 months with hospice admission and 5.8 months without hospice (P = .11). Four of eight intensity-of-care indicators (ie, intensive care unit [ICU] admission within last month of life, > one hospitalization within last month of life, hospital death, and hospice referral < 3 days before death) all significantly exceeded the referenced benchmarks. Hospice versus nonhospice admissions were associated (P < .001) with ICU admissions (2% v 13%) and hospital deaths (2% v 54%). Conclusion: These data suggest opportunities to improve community cancer center EOL care.
Cowall, David E.; Yu, Bennett W.; Heineken, Sandra L.; Lewis, Elizabeth N.; Chaudhry, Vishal; Daugherty, Joan M.
Background: Colorectal cancer (CRC) screening is recommended for all adults 50-75 years old, yet only slightly more than one-half of eligible people are current with screening. Since CRC screening is usually initiated upon recommendations of primary care physicians, interventions in these settings are needed to improve screening. Objectives: To assess the impact of a quality improvement (QI) intervention combining electronic medical record (EMR) based audit and feedback, practice site visits for academic detailing and participatory planning, and “best-practice” dissemination on CRC screening in primary care practice. Research Design: Two year group-randomized trial. Subjects: Physicians, mid-level providers and clinical staff members in 32 primary care practices in 19 States caring for 68,150 patients 50 years of age or older. Measures: Proportion of active patients up to date (UTD) with CRC screening (colonoscopy within 10 years, sigmoidoscopy within 5 years, or at home fecal occult blood testing within 1 year) and having screening recommended within past year among those not UTD. Results: Patients 50-75 years in intervention practices exhibited significantly greater improvement (from 60.7% to 71.2%) in being UTD with CRC screening than patients in control practices (from 57.7% to 62.8%), the adjusted difference being 4.9% (95% CI: 3.8% to 6.1%). Recommendations for screening also increased more in intervention practices with the adjusted difference being 7.9% (95%CI: 6.3% to 9.5%). There was wide inter-practice variation in CRC screening throughout the intervention. Conclusions: A multi-component QI intervention in practices that use EMR can improve colorectal cancer screening.
Ornstein, Steven; Nemeth, Lynne S.; Jenkins, Ruth G.; Nietert, Paul J.
Background Immigration and asylum seeking has been an important social and political phenomenon in Ireland since the mid 1990s. Inward migration to Ireland was seen in unprecedented numbers from 1995 onward, peaking in 2002 with 11,634 applications for refugee status. Asylum and immigration is an issue of national and international relevance as the numbers of displaced people worldwide continues to grow, reaching the highest level in 20 years at 45.2 million in 2012. Midwives provide the majority of care to childbearing women around the world, whether working as autonomous practitioners or under the direction of an obstetrician. Limited data currently exist on the perspectives of midwives who providecare to childbearing women while they are in the process of seeking asylum. Such data are important to midwifery leaders, educators, and policy-makers. The aims of this study were to explore midwives’ perceptions and experiences of providingcare to women in the asylum process and to gain insight into how midwives can be equipped and supported to provide more effective care to this group in the future. Methods Data were collected via indepth unstructured interviews with a purposive sample of ten midwives from two sites, one a large urban inner city hospital, and the second, a smaller more rural maternity hospital. The interviews were audio-recorded and transcribed verbatim. The data were analyzed using content analysis. Results Five themes emerged from the data, barriers to communication, understanding cultural difference, challenges of caring for women who were unbooked, the emotional cost of caring, and structural barriers to effective care. Conclusion Findings highlight a need to focus on support and education for midwives, improved maternity services for immigrant women, and urgent policy revision.
Many survivors of adolescent and young adult cancers avoid routine medical care because it's too expensive, despite the fact that most have health insurance. That is the conclusion of a new study published early online in Cancer.
Introduction: Job satisfaction is determined by a discrepancy between what one wants in a job and what one has in a job. The core components of information necessary for what satisfies and motivates the health work force in our country are missing at policy level. Therefore present study will help us to know the factors for job satisfaction among primary health careproviders in public sector. Materials and Methods: Present study is descriptive in nature conducted in public sector dispensaries/primary urban health centers in Delhi among health careproviders. Pretested structured questionnaire was administered to 227 health careproviders. Data was analyzed using SPSS and relevant statistical test were applied. Results: Analysis of study reveals that ANMs are more satisfied than MOs, Pharmacist and Lab assistants/Lab technicians; and the difference is significant (P < 0.01). Age and education level of health careproviders don’t show any significant difference in job satisfaction. All the health careproviders are dissatisfied from the training policies and practices, salaries and opportunities for career growth in the organization. Majority of variables studied for job satisfaction have low scores. Five factor were identified concerned with job satisfaction in factor analysis. Conclusion: Job satisfaction is poor for all the four groups of health careproviders in dispensaries/primary urban health centers and it is not possible to assign a single factor as a sole determinant of dissatisfaction in the job. Therefore it is recommended that appropriate changes are required at the policy as well as at the dispensary/PUHC level to keep the health work force motivated under public sector in Delhi.
Kumar, Pawan; Khan, Abdul Majeed; Inder, Deep; Sharma, Nandini
Premenopausal women with a new diagnosis of breast cancer are faced with many challenges. Providing health care for issues such as gynecologic comorbidities, reproductive health concerns, and vasomotor symptom control can be complicated because of the risks of hormone treatments and the adverse effects of adjuvant therapies. It is paramount that health care professionals understand and be knowledgeable about hormonal and nonhormonal treatments and their pharmacological parameters so they can offer appropriate care to women who have breast cancer, with the goal of improving quality of life. Articles for this review were identified by searching the PubMed database with no date limitations. The following search terms were used: abnormal uterine bleeding, physiologic sex steroids, endometrial ablation, hysteroscopic sterilization, fertility preservation in endometrial cancer, tranexamic acid and breast cancer, menorrhagia treatment and breast cancer, abnormal uterine bleeding and premenopausal breast cancer, levonorgestrel IUD and breast cancer, tamoxifen and gynecologic abnormalities, tamoxifen metabolism, hormones and breast cancer risk, contraception and breast cancer, pregnancy and breast cancer, and breast cancer and infertility treatment.
This study assesses whether California’s minimum nurse staffing legislation affected the amount of uncompensated careprovided by California hospitals. Using data from California’s Office of Statewide Health Planning and Development, the American Hospital Association Annual Survey and InterStudy, we divide hospitals into quartiles based on pre-regulation staffing levels. Controlling for other factors, we estimate changes in the growth rate of uncompensated care in the three lowest staffing quartiles relative to the quartile of hospitals with the highest staffing level. Our sample includes short-term general hospitals over the period 1999 to 2006. We find that growth rates in uncompensated care are lower in the first three staffing quartiles as compared to the highest quartile; however, results are statistically significant only for county and for-profit hospitals in quartiles one and three. We conclude that minimum nurse staffing ratios may lead some hospitals to limit uncompensated care, likely due to increased financial pressure.
Harless, David W.; Pink, George H.; Spetz, Joanne; Mark, Barbara
Actions under the False Claims Act represent potentially billions of dollars in damages returned to the state and federal governments each year for fraud recovery. Over the past several years, health careproviders have been the target of about half of the FCA suits filed and have paid out an even greater percentage of the damages recovered. Because of the enumerable opportunities for fraud, waste, and abuse in the health care industry, it will likely continue to be a prominent target of FCA suits. Key provisions of the Deficit Reduction Act of 2005, effective on January 1, 2007, will only increase the reach of the FCA. Providers beware. PMID:19175229
Bone health and maintenance of bone integrity are important components of comprehensive cancercare in both early and late stages of disease. Risk factors for osteoporosis are increased in patients with cancer, including women with chemotherapy-induced ovarian failure, those treated with aromatase inhibitors for breast cancer, men receiving androgen-deprivation therapy for prostate cancer, and patients undergoing glucocorticoid therapy. The skeleton is a common site of metastatic cancer recurrence, and skeletal-related events are the cause of significant morbidity. The National Comprehensive Cancer Network (NCCN) convened a multidisciplinary task force on Bone Health in CancerCare to discuss the progress made in identifying effective screening and therapeutic options for management of treatment-related bone loss; understanding the factors that result in bone metastases; managing skeletal metastases; and evolving strategies to reduce bone recurrences. This report summarizes presentations made at the meeting.
Gralow, Julie R.; Biermann, J. Sybil; Farooki, Azeez; Fornier, Monica N.; Gagel, Robert F.; Kumar, Rashmi N.; Shapiro, Charles L.; Shields, Andrew; Smith, Matthew R.; Srinivas, Sandy; Van Poznak, Catherine H.
Background Patients in American hospitals receive intensive medical treatments. However, when lifesaving treatments are unsuccessful, patients often die in the hospital with distressing symptoms while receiving burdensome care. Systematic measurement of the quality of care planning and symptom palliation is needed. Methods Medical records were abstracted using sixteen Assessing Care of Vulnerable Elders quality indicators within the domains of end of life care and pain management designed to measure the quality of the dying experience for adult decedents hospitalized for at least 3 days between April 2005 and April 2006 (n=496) at a university medical center recognized for providing intensive care for the seriously ill. Results Over half of the patients (mean age 62, 47% female), were admitted to the hospital with end stage disease and 28% were age 75 or older. One third of the patients required extubation from mechanical ventilation prior to death and 15% died while receiving CPR. Overall, patients received recommended care for 70% of applicable indicators (range 25%–100%). Goals of care were addressed in a timely fashion for patients admitted to the ICU approximately half of the time, while pain assessments (94%) and treatments for pain (95%) and dyspnea (87%) were performed with fidelity. Follow-up for distressing symptoms was performed less well than initial assessment and 29% of patients extubated in anticipation of death had documented dyspnea assessments. Conclusions A practical, chart-based assessment identified discrete deficiencies in care planning and symptom palliation that can be targeted to improve care for patients dying in the hospital.
Walling, Anne M.; Asch, Steven M.; Lorenz, Karl A.; Roth, Carol P.; Barry, Tod; Kahn, Katherine L.; Wenger, Neil S.
Social objectives are poorly specified and evaluated in cancercare. Palliative day care is an example where social objectives are often identified but research has focused on health-care outcomes. A literature review identifies four types of social objective: emotional and spiritual care, general social care, services for families and carers and creative arts. Social objectives include: distinguishing between therapeutic work and leisure and supportive interventions, promoting service continuity, reducing social isolation, increasing social interaction, reassuring introduction to palliative care, rehearsal of reactions to illness with a sympathetic audience, integration of families and carers into care services, respite for carers and creative work for three separable objectives. It is argued that interventions to achieve social objectives may be defined and evaluated in a measurable way. Similarly, social objectives and interventions can be specified at other stages in the cancer journey. PMID:17177900
In the care of older people, unexpected and unpredictable situations often occur, which sometimes involve challenging ethical decision-making. This study starts off from an ethical perspective with caritative caring as the theoretical framework. The aim of this descriptive study is to describe what possibilities care givers regard themselves to have to provide good care based on ethical values in the daily care of older persons. A total of 105 (95%) care givers answered the questionnaire. The study was conducted in a municipality in the Western part of Finland during the spring of 2007. The result shows that good care based on ethical values cannot always be guaranteed in the care of older person. There are possibilities to provide the older person with individual, dignified and safe care, and to establish a caring communion and closeness in care, but without positioning these results in relation to an ethical discussion, we cannot state that the care is good enough. PMID:23621476
The Centers for Medicare & Medicaid Services (CMS) today issued two national coverage decisions for improving care for cancer patients by expanding coverage for diagnostic tests and chemotherapy treatments for Medicare beneficiaries.
To determine prevalence and predictors of complementary and alternative medicine (CAM) use disclosure to health careproviders and whether CAM use disclosure is associated with highly active antiretroviral therapy (HAART) adherence among HIV-infected women, we analyzed longitudinal data collected between October 1994 and March 2002 from HIV-infected CAM-using women enrolled in the Women's Interagency HIV Study. Repeated measures Poisson regression models were constructed to evaluate associations of selected predictors with CAM use disclosure and association between CAM use disclosure and HAART adherence. A total of 1,377 HIV-infected women reported CAM use during study follow-up and contributed a total of 4,689 CAM-using person visits. The overall prevalence of CAM use disclosure to health careproviders was 36% across study visits. Women over 45 years old, with a college education, or with health insurance coverage were more likely to disclose their CAM use to health careproviders, whereas women identified as non-Hispanic Black or other ethnicities were less likely to communicate their CAM usage. More health careprovider visits, more CAM domains used, and higher health care satisfaction scores had significant relationships with increased levels of CAM use disclosure. Restricting analysis to use of herbal or nonherbal medications only, similar results were obtained. Compared to other CAM domains, mind-body practice had the lowest prevalence of CAM use disclosure. Additionally, CAM use disclosure was significantly associated with higher HAART adherence. From this study, we showed that a high percentage of HIV-infected women did not discuss their CAM use with health careproviders. Interventions targeted towards both physicians and patients may enhance communication of CAM use, avoid potential adverse events and drug interactions, and enhance HAART adherence. PMID:19821723
Abstract To determine prevalence and predictors of complementary and alternative medicine (CAM) use disclosure to health careproviders and whether CAM use disclosure is associated with highly active antiretroviral therapy (HAART) adherence among HIV-infected women, we analyzed longitudinal data collected between October 1994 and March 2002 from HIV-infected CAM-using women enrolled in the Women's Interagency HIV Study. Repeated measures Poisson regression models were constructed to evaluate associations of selected predictors with CAM use disclosure and association between CAM use disclosure and HAART adherence. A total of 1377 HIV-infected women reported CAM use during study follow-up and contributed a total of 4689 CAM-using person visits. The overall prevalence of CAM use disclosure to health careproviders was 36% across study visits. Women over 45 years old, with a college education, or with health insurance coverage were more likely to disclose their CAM use to health careproviders, whereas women identified as non-Hispanic Black or other ethnicities were less likely to communicate their CAM usage. More health careprovider visits, more CAM domains used, and higher health care satisfaction scores had significant relationships with increased levels of CAM use disclosure. Restricting analysis to use of herbal or nonherbal medications only, similar results were obtained. Compared to other CAM domains, mind–body practice had the lowest prevalence of CAM use disclosure. Additionally, CAM use disclosure was significantly associated with higher HAART adherence. From this study, we showed that a high percentage of HIV-infected women did not discuss their CAM use with health careproviders. Interventions targeted towards both physicians and patients may enhance communication of CAM use, avoid potential adverse events and drug interactions, and enhance HAART adherence.
A FASEB Horizons in Bioscience Publication. This publication discusses how biomedical research of in vitro fertilization (IVF) and cryopreservation (freezing) of embryos is helping female cancer survivors have children.
Wide-scale point-of-care diagnostic systems hold great promise for early detection of cancer at a curable stage of the disease. This review discusses the prospects and challenges of electrochemical biosensors for next-generation cancer diagnostics. Electrochemical biosensors have played an important significant role in the transition towards point-of-care diagnostic devices. Such electrical devices are extremely useful for delivering the diagnostic information in
...2009-10-01 false Special requirements for CAH providers of long-term care services... Â§ 485.645 Special requirements for CAH providers of long-term care services (âswing-bedsâ) A CAH must meet the following...
...2010-10-01 false Special requirements for CAH providers of long-term care services... Â§ 485.645 Special requirements for CAH providers of long-term care services (âswing-bedsâ) A CAH must meet the following...
...false Does FTCA coverage extend to the contractor's health care practitioners providing services to private patients on a fee-for-services...195 Does FTCA coverage extend to the contractor's health care practitioners providing services to private patients on a...
Report of an experience of nursing students in providingcare to a patient with epidermodysplasia verruciformis, during the internship in the discipline Nursing in Transmittable Diseases, at the dermatology ward of a teaching hospital, located in the state of São Paulo, Brazil, in 2009. This is a rare genodermatosis, susceptible to infection with different types of human papilloma viruses, that cause exacerbated physical changes that impact the psyche of the affected individual. Care delivery was based on the assistance complexity indicated by the application of the Patient Classification System proposed by Perroca. The experience allowed students to learn how to cope with a patient affected by a rare and complex disease, of difficult resolution, and to provide integral care to this individual, perceiving him beyond the lesions. One conclude that the experience has greatly contributed to the growth of the students as future professionals. PMID:24008720
Correa, Bruna Maria Cinel; Bolgue, Ana Paula Munhoz; de Oliveira, Ana Paola Piloto; Ayres, Jairo Aparecido; Paiva, Bianca Sakamoto Ribeiro
A health insurer in Michigan, through its Physician Group Incentive Program, engaged providers across the state in a collection of financially incentivized initiatives to transform primary care and improve quality. We investigated physicians' and other program stakeholders' perceptions of the program through semistructured interviews with more than 80 individuals. We found that activities across five areas contributed to successful provider engagement: (1) developing a vision of improving primary care, (2) deliberately fostering practice-practice partnerships, (3) using existing infrastructure, (4) leveraging resources and market share, and (5) managing program trade-offs. Our research highlights effective strategies for engaging primary care physicians in program design and implementation processes and creating learning communities to support quality improvement and practice change. PMID:24400458
Smoking among childhood and young adult cancer survivors may increase risk for late effects of treatment, and survivors need assistance in quitting. This paper reports on the prevalence of discussions between childhood cancer survivors and their health careproviders about smoking cessation and pharmacotherapy and explores factors that are associated with these discussions. This is a longitudinal study that included 329 smokers who were childhood or young adult cancer survivors, recruited from five cancer centers in the USA and Canada. Fifty-five percent of smokers reported receiving advice to quit smoking from their regular provider during the study period, and only 36 % of smokers reported discussing pharmacotherapy with their provider. Receipt of advice was associated with being female and having a heavier smoking rate. Pharmacotherapy discussions were associated with readiness to quit, heavier smoking rate, and previous provider advice to quit. Health careproviders are missing key opportunities to advise cancer survivors about cessation and evidence-based interventions. Systematic efforts are needed to ensure that survivors who smoke get the treatment that they need. PMID:23894256
Emmons, Karen M; Sprunck-Harrild, Kim; Puleo, Elaine; de Moor, Janet
The delivery of affordable and equitable cancercare is one of India's greatest public health challenges. Public expenditure on cancer in India remains below US$10 per person (compared with more than US$100 per person in high-income countries), and overall public expenditure on health care is still only slightly above 1% of gross domestic product. Out-of-pocket payments, which account for more than three-quarters of cancer expenditures in India, are one of the greatest threats to patients and families, and a cancer diagnosis is increasingly responsible for catastrophic expenditures that negatively affect not only the patient but also the welfare and education of several generations of their family. We explore the complex nature of cancercare systems across India, from state to government levels, and address the crucial issues of infrastructure, manpower shortages, and the pressing need to develop cross-state solutions to prevention and early detection of cancer, in addition to governance of the largely unregulated private sector and the cost of new technologies and drugs. We discuss the role of public insurance schemes, the need to develop new political mandates and authority to set priorities, the necessity to greatly improve the quality of care, and the drive to understand and deliver cost-effective cancercare programmes. PMID:24731888