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Quality improvement in primary care

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https://www.readbyqxmd.com/read/28088380/aquatic-exercise-therapy-for-people-with-parkinson-s-disease-a-randomized-controlled-trial
#1
Louise M Carroll, Daniele Volpe, Meg E Morris, Jean Saunders, Amanda M Clifford
OBJECTIVE: To evaluate the effects of aquatic exercise therapy on gait variability and disability compared to usual care for people with Parkinson's disease (PD). DESIGN: Single-blind randomized control trial (RCT). SETTING: A community based hydrotherapy pool in Ireland. PARTICIPANTS: Twenty one individuals with PD (Hoehn-Yahr Stages I-III). INTERVENTIONS: Participants were randomly assigned to either an aquatic exercise therapy group (45 minutes, twice a week for 6 weeks) or a control group that received usual care...
January 11, 2017: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/28086976/impact-of-a-tailored-program-on-the-implementation-of-evidence-based-recommendations-for-multimorbid-patients-with-polypharmacy-in-primary-care-practices-results-of-a-cluster-randomized-controlled-trial
#2
Cornelia Jäger, Tobias Freund, Jost Steinhäuser, Christian Stock, Johannes Krisam, Petra Kaufmann-Kolle, Michel Wensing, Joachim Szecsenyi
BACKGROUND: Multimorbid patients receiving polypharmacy represent a growing population at high risk for negative health outcomes. Tailoring is an approach of systematic intervention development taking account of previously identified determinants of practice. The aim of this study was to assess the effect of a tailored program to improve the implementation of three important processes of care for this patient group: (a) structured medication counseling including brown bag reviews, (b) the use of medication lists, and (c) structured medication reviews to reduce potentially inappropriate medication...
January 13, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/28086887/patients-and-physicians-perceptions-and-attitudes-about-oral-anticoagulation-and-atrial-fibrillation-a-qualitative-systematic-review
#3
Gemma Mas Dalmau, Elisenda Sant Arderiu, María Belén Enfedaque Montes, Ivan Solà, Sandra Pequeño Saco, Pablo Alonso Coello
BACKGROUND: Oral anticoagulant therapy reduces the risk of stroke in patients with atrial fibrillation, but many patients are still not prescribed this therapy. The causes of underuse of vitamin K antagonists oral anticoagulants are not clear but could be related, in part, to patients' and physicians' perceptions and attitudes towards the benefits and downsides of this treatment. The purpose of this systematic review was to evaluate and synthesize patients' and physicians' perceptions and attitudes towards the benefits and downsides of vitamin K antagonist, in order to explore potential factors related with its underuse...
January 13, 2017: BMC Family Practice
https://www.readbyqxmd.com/read/28086870/a-pilot-study-of-a-community-health-agent-led-type-2-diabetes-self-management-program-using-motivational-interviewing-based-approaches-in-a-public-primary-care-center-in-s%C3%A3-o-paulo-brazil
#4
Thais Moura Ribeiro do Valle Nascimento, Ken Resnicow, Marcia Nery, Alexandra Brentani, Elizabeth Kaselitz, Pooja Agrawal, Simanjit Mand, Michele Heisler
BACKGROUND: Rates of noncommunicable diseases (NCDs) such as type 2 diabetes are escalating in low and middle-income countries such as Brazil. Scalable primary care-based interventions are needed to improve self-management and clinical outcomes of adults with diabetes. This pilot study examines the feasibility, acceptability, and outcomes of training community health agents (CHAs) in Motivational Interviewing (MI)-based counseling for patients with poorly controlled diabetes in a primary care center in São Paulo, Brazil...
January 13, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28086867/process-evaluation-of-an-integrated-care-pathway-in-geriatric-rehabilitation-for-people-with-complex-health-problems
#5
Irma H J Everink, Jolanda C M van Haastregt, Jose M C Maessen, Jos M G A Schols, Gertrudis I J M Kempen
BACKGROUND: An integrated care pathway in geriatric rehabilitation was developed to improve coordination and continuity of care for community-living older adults in the Netherlands, who go through the process of hospital admission, admission to a geriatric rehabilitation facility and discharge back to the home situation. This pathway is a complex intervention and is focused on improving communication, triage and transfers of patients between the hospital, geriatric rehabilitation facility and primary care organisations...
January 13, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28086813/information-exchange-networks-of-health-care-providers-and-evidence-based-cardiovascular-risk-management-an-observational-study
#6
Naomi Heijmans, Jan van Lieshout, Michel Wensing
BACKGROUND: Although a wide range of preventive and clinical interventions has targeted cardiovascular risk management (CVRM), outcomes remain suboptimal. Therefore, the question is what additional determinants of CVRM and outcomes can be identified and addressed to optimize CVRM. In this study, we aimed to identify new perspectives for improving healthcare delivery and explored associations between information exchange networks of health care providers and evidence-based CVRM. METHODS: This observational study was performed parallel to a randomized clinical trial which aimed to improve professional performance of practice nurses in the Netherlands...
January 13, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/28079970/categorizing-the-magnitude-and-frequency-of-exposure-to-uncivil-behaviors-a-new-approach-for-more-meaningful-interventions
#7
Dena Evans
PURPOSE: To examine turnover intentions, as well as the prevalence and frequency of uncivil behaviors, from the perspective of registered nurses, respiratory therapists, and imaging professionals, using a new method to categorize exposure magnitude. DESIGN AND METHODS: Data were collected using the 22-item Negative Acts Questionnaire-Revised (NAQ-R). Additional items, informed by Price and Mueller's causal model of turnover, were included, as were select demographic variables...
January 12, 2017: Journal of Nursing Scholarship
https://www.readbyqxmd.com/read/28079809/a-comparison-of-the-surgical-mortality-due-to-colorectal-perforation-at-different-hospitals-with-data-from-10-090-cases-in-the-japanese-national-clinical-database
#8
Takeshi Ohki, Masakazu Yamamoto, Hiroaki Miyata, Yasuto Sato, Yoshihisa Saida, Tsuyoshi Morimoto, Hiroyuki Konno, Yasuyuki Seto, Koichi Hirata
Colorectal perforation has a high rate of mortality. We compared the incidence and fatality rates of colorectal perforation among different hospitals in Japan using data from the nationwide surgical database.Patients were registered in the National Clinical Database (NCD) between January 1st, 2011 and December 31st, 2013. Patients with colorectal perforation were identified from surgery records by examining if acute diffuse peritonitis (ADP) and diseases associated with a high probability of colorectal perforation were noted...
January 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28079774/a-statewide-progestogen-promotion-program-in-ohio
#9
Jay D Iams, Mary S Applegate, Michael P Marcotte, Martha Rome, Michael A Krew, Jennifer L Bailit, Heather C Kaplan, Jessi Poteet, Melissa Nance, David S McKenna, Hetty C Walker, Jennifer Nobbe, Lakshmi Prasad, Maurizio Macaluso, Carole Lannon
OBJECTIVE: To promote use of progestogen therapy to reduce premature births in Ohio by 10%. METHODS: The Ohio Perinatal Quality Collaborative initiated a quality improvement project in 2014 working with clinics at 20 large maternity hospitals, Ohio Medicaid, Medicaid insurers, and service agencies to use quality improvement methods to identify eligible women and remove treatment barriers. The number of women eligible for prophylaxis, the percent prescribed a progestogen before 20 and 24 weeks of gestation, and barriers encountered were reported monthly...
January 9, 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28079645/the-role-of-patient-navigators-in-building-a-medical-home-for-multiply-diagnosed-hiv-positive-homeless-populations
#10
Mariana Sarango, Alexander de Groot, Melissa Hirschi, Chukwuemeka Anthony Umeh, Serena Rajabiun
CONTEXT: People living with human immunodeficiency virus (HIV) (PLWH) who are most at risk for falling out of HIV primary care and detectable viral loads include homeless and unstably housed individuals and those codiagnosed with behavioral health disorders. The patient-centered medical home (PCMH) is a model that promotes provision of comprehensive, patient-centered, accessible, coordinated, and quality care for patients. This initiative provided patient navigation to HIV-positive homeless and unstably housed individuals codiagnosed with a mental health or substance use disorder as a means to create an adapted PCMH to meet the specific needs of this population...
January 11, 2017: Journal of Public Health Management and Practice: JPHMP
https://www.readbyqxmd.com/read/28077205/impact-of-pharmacists-in-optimizing-geriatric-pharmacotherapy-in-primary-care-within-a-veterans-affairs-medical-center
#11
Taryn B Mondiello, Lauren A Stutzman
OBJECTIVE: To assess pharmacists' impact on optimizing pharmacotherapy among geriatric patients. DESIGN: Single-site, prospective, quality-improvement project. SETTING: Primary care at a Veterans Affairs medical center. PARTICIPANTS: Thirteen males 75 years of age and older were included. INTERVENTIONS: Recommendations were made by pharmacists to optimize prescribing. MAIN OUTCOME MEASURES: Differences between specific instances of suboptimal prescribing before and after pharmacists' recommendations, the percentage of pharmacists' recommendations accepted, and the top most commonly prescribed psychotropic medications and their most common indications...
January 1, 2017: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/28076671/a-randomized-trial-of-collaborative-care-for-perinatal-depression-in-socioeconomically-disadvantaged-women-the-impact-of-comorbid-posttraumatic-stress-disorder
#12
Nancy K Grote, Wayne J Katon, Joan E Russo, Mary Jane Lohr, Mary Curran, Erin Galvin, Kathy Carson
OBJECTIVE: The comorbidity of posttraumatic stress disorder (PTSD) with antenatal depression poses increased risks for postpartum depression and may delay or diminish response to evidence-based depression care. In a secondary analysis of an 18-month study of collaborative care for perinatal depression, the authors hypothesized that pregnant, depressed, socioeconomically disadvantaged women with comorbid PTSD would show more improvement in the MOMCare intervention providing Brief Interpersonal Psychotherapy and/or antidepressants, compared to intensive public health Maternity Support Services (MSS-Plus)...
November 2016: Journal of Clinical Psychiatry
https://www.readbyqxmd.com/read/28076546/pharmacist-s-contribution-to-the-promotion-of-access-and-rational-use-of-essential-medicines-in-sus
#13
Daniela Oliveira de Melo, Lia Lusitana Cardozo de Castro
Objective: to describe the pharmaceutical inclusion process in a Basic Health Unit multidisciplinary team and evaluate results related to rational use and promotion of access to essential medicines. Methods: This is a descriptive, cross-sectional study conducted in a primary care health unit in the city of São Paulo. Pharmacist's activities were evaluated regarding the service structure and organization and prescribing quality improvement, guidance method creation, and implementation of clinical pharmacy service...
January 2017: Ciência & Saúde Coletiva
https://www.readbyqxmd.com/read/28076441/effects-of-an-integrated-fast-track-rehabilitation-service-for-multi-trauma-patients-a-non-randomized-clinical-trial-in-the-netherlands
#14
Ans I E Bouman, Bea Hemmen, Silvia M A A Evers, Henk van de Meent, Ton Ambergen, Pieter E Vos, Peter R G Brink, Henk A M Seelen
OBJECTIVES: The effects on health related outcomes of a newly-developed rehabilitation program, called 'supported Fast Track multi-trauma rehabilitation service' (Fast Track), were evaluated in comparison with conventional trauma rehabilitation service (Care as Usual). METHODS: Prospective, multi-center, non-randomized controlled study. Between 2009 and 2012, 132 adult multi-trauma patients were included: 65 Fast Track and 67 Care as Usual patients with an Injury Severity Score ≥16, complex multiple injuries in several extremities or complex pelvic and/or acetabulum fractures...
2017: PloS One
https://www.readbyqxmd.com/read/28075696/dual-eligibles-experience-of-care-with-north-carolina-s-patient-centered-medical-home
#15
Sarah Grantham, Debora Goetz Goldberg, Donna Lind Infeld
Although individuals enrolled in both Medicare and Medicaid (dual eligibles) are among those with the nation's greatest need, at $300 billion per year, their care is also expensive and beset by quality problems. Previous research found problems associated with inadequate coordination of benefits and services; however, these studies have largely used quantitative approaches and focused on providers-few studies have explored the perspective of dual eligible patients. In an effort to improve care and reduce costs, North Carolina (NC) developed a Patient-Centered Medical Home (PCMH) model centered on a continuous relationship with a primary care provider who is responsible for coordination of services and addressing patients' health care needs by providing direct services or arranging care with other qualified professionals...
January 11, 2017: Population Health Management
https://www.readbyqxmd.com/read/28075489/cough-augmentation-techniques-for-extubation-or-weaning-critically-ill-patients-from-mechanical-ventilation
#16
REVIEW
Louise Rose, Neill Kj Adhikari, David Leasa, Dean A Fergusson, Douglas McKim
BACKGROUND: There are various reasons why weaning and extubation failure occur, but ineffective cough and secretion retention can play a significant role. Cough augmentation techniques, such as lung volume recruitment or manually- and mechanically-assisted cough, are used to prevent and manage respiratory complications associated with chronic conditions, particularly neuromuscular disease, and may improve short- and long-term outcomes for people with acute respiratory failure. However, the role of cough augmentation to facilitate extubation and prevent post-extubation respiratory failure is unclear...
January 11, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28075337/implementation-of-point-of-care-diagnostics-in-rural-primary-healthcare-clinics-in-south-africa-perspectives-of-key-stakeholders
#17
Tivani P Mashamba-Thompson, Ngcwalisa A Jama, Benn Sartorius, Paul K Drain, Rowan M Thompson
INTRODUCTION: Key stakeholders' involvement is crucial to the sustainability of quality point-of-care (POC) diagnostics services in low-and-middle income countries. The aim of this study was to explore key stakeholder perceptions on the implementation of POC diagnostics in rural primary healthcare (PHC) clinics in South Africa. METHOD: We conducted a qualitative study encompassing in-depth interviews with multiple key stakeholders of POC diagnostic services for rural and resource-limited PHC clinics...
January 8, 2017: Diagnostics
https://www.readbyqxmd.com/read/28073791/rapid-deployment-aortic-replacement-radar-registry-in-spain-a-protocol
#18
Victor Bautista-Hernandez, Natalia Cal-Purriños, Jose M Arribas-Leal, Manuel Carnero-Alcazar, Jose F Gutierrez-Diez, Jose J Cuenca-Castillo
INTRODUCTION: Rapid deployment valves (RDV) represent a newly introduced approach to aortic valve replacement which facilitates surgical implantation and minimally invasive techniques, shortens surgical times and shows excellent haemodynamic performance. However, evidence on their safety, efficacy and potential complications is mostly fitted with small-volume and retrospective studies. Moreover, no current guidelines exist. To improve our knowledge on this technology, The Rapid Deployment Aortic Replacement (RADAR) Registry will be established across Spain with the aim of assessing RDV outcomes in the real-world setting...
January 10, 2017: BMJ Open
https://www.readbyqxmd.com/read/28072893/a-pediatric-application-of-the-strac-regional-hospital-trauma-registry-database-pediatric-trauma-deaths-in-south-central-texas-during-2004-2013
#19
Michelle Buehner, Jay Aden, Mathew Borgman, Preston Love, Brandi Wright, Mary Edwards
The purpose of this study was to define the demographics of pediatric traumatic injuries and to understand the predictive value of injury type, prehospital, and emergency department (ED) data regarding the mortality of pediatric trauma patients (<14 years of age) in South Central Texas. We report a retrospective review of pediatric trauma patients presenting to Trauma Service Area P in South Central Texas during 2004-2013. The primary outcome was mortality; secondary outcomes were ventilator days, hospital days, and intensive care unit stay...
January 1, 2017: Texas Medicine
https://www.readbyqxmd.com/read/28072666/outcomes-from-referrals-and-unscheduled-visits-from-community-emergency-departments-to-a-regional-pediatric-emergency-department-in-canada
#20
Ethan Reiner, Ardalan Ahmadi, Eric Grafstein, Quynh Doan
OBJECTIVES: Existing pediatric literature describing repeat visits to the emergency department (ED) for the same medical complaint has yet to report on patient flow patterns from general EDs (GEDs) to a pediatric ED (PED). We sought to characterize the population of patients who are treated in a GED and subsequently present to a PED for further care. METHODS: We conducted a retrospective cohort study reviewing all pediatric visits (age < 17 y) at 5 GEDs in Vancouver...
January 9, 2017: Pediatric Emergency Care
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