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home based primary care

Derenda Lovelace, Diane Hancock, Sabrina S Hughes, Phyllis R Wyche, Claire Jenkins, Cindy Logan
BACKGROUND: In 2011, the Hunter Holmes McGuire Veterans Administration Medical Center (VAMC) in Richmond, VA, had a cumulative readmission rate and emergency department (ED) revisits for discharged Veterans of 1 in 5. In 2012, a transitional care program (TCP) was implemented to improve care coordination and outcomes among Veterans, with an emphasis on geriatric patients with chronic disease. This TCP was created with an interdisciplinary approach using intensive case management interventions, with a goal of reducing Veteran ED and hospital revisits by 30%...
November 2016: Professional Case Management
Karen Thomson, Sophie R Pestieau, Janish J Patel, Heather Gordish-Dressman, Ariana Mirzada, Zeev N Kain, Matthew E Oetgen
BACKGROUND: The Perioperative Surgical Home (PSH) is a patient-centered, team-based approach that aims to improve the value of perioperative care. We implemented a PSH for patients with adolescent idiopathic scoliosis who were undergoing posterior spinal fusion at Children's National Health System. We hypothesized that this PSH would improve patient surgical outcomes and reduce hospital length of stay (LOS). METHODS: A multidisciplinary group created evidence-based protocols for the preoperative, operative, postoperative, and postdischarge care of this patient population...
October 3, 2016: Anesthesia and Analgesia
Victoria Shier, Eric Trieu, David A Ganz
BACKGROUND: The United States Preventive Services Task Force recommends exercise to prevent falls in community-dwelling adults aged ≥ 65 years at increased fall risk. However, little is known about how best to implement exercise programs in routine care when a patient's need for exercise is identified within the healthcare system. METHODS: Using a qualitative approach, we reviewed the literature to determine how exercise programs to prevent falls are implemented from the vantage point of a health care setting...
December 2016: Injury Epidemiology
Stefan Stefanovic, Markus Wallwiener, Uros Karic, Christoph Domschke, Luka Katic, Florin-Andrei Taran, Aleksandra Pesic, Andreas Hartkopf, Peyman Hadji, Martin Teufel, Florian Schuetz, Christof Sohn, Peter Fasching, Andreas Schneeweiss, Sara Brucker
PURPOSE: The capture of adequate treatment outcomes and quality of life (QOL) of advanced breast cancer patients in clinical routine represents a great challenge. Patient-reported outcomes (PROs) are data elements directly reported by patients about experiences with care, including symptoms, functional status, or quality of life. There is growing interest in the medical community for the evaluation and implementation of PROs of adverse events (PRO-AEs). Recent interest in PROs in health care has evolved in the context of patient centeredness...
October 17, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Mandira Paul, Sharad D Iyengar, Birgitta Essén, Kristina Gemzell-Danielsson, Kirti Iyengar, Johan Bring, Marie Klingberg-Allvin
BACKGROUND: Post-abortion contraceptive use in India is low and the use of modern methods of contraception is rare, especially in rural areas. This study primarily compares contraceptive use among women whose abortion outcome was assessed in-clinic with women who assessed their abortion outcome at home, in a low-resource, primary health care setting. Moreover, it investigates how background characteristics and abortion service provision influences contraceptive use post-abortion. METHODS: A randomized controlled, non-inferiority, trial (RCT) compared clinic follow-up with home-assessment of abortion outcome at 2 weeks post-abortion...
October 17, 2016: BMC Public Health
Gerald Kayingo, Owais Gilani, Vasco Deon Kidd, Mary L Warner
BACKGROUND AND OBJECTIVES: The transformation of primary care (PC) training sites into patient-centered medical homes (PCMH) has implications for the education of health professionals. This study investigates the extent to which physician assistant (PA) students report learning about the PCMH model and how clinical exposure to PCMH might impact their interest in a primary care career. METHODS: An electronic survey was distributed to second-year PA students who had recently completed their PC rotation from 12 PA programs...
October 2016: Family Medicine
Cari Levy, Emily A Whitfield
OBJECTIVE: To compare characteristics, healthcare use, and costs of care of veterans in the rapidly expanding Veterans Health Administration (VHA) medical foster home (MFH) with those of three other VHA long-term care (LTC) programs. DESIGN: Descriptive, unmatched study. SETTING: VHA MFHs, home-based primary care (HBPC), community living centers (CLCs), and community nursing homes (CNHs). PARTICIPANTS: Veterans newly enrolled in one of the four LTC settings in calendar years 2010 or 2011...
October 14, 2016: Journal of the American Geriatrics Society
Anika Thielmann, Biljana Gerasimovska-Kitanovska, Krzysztof Buczkowski, Tuomas H Koskela, Vildan Mevsim, Slawomir Czachowski, Ferdinando Petrazzuoli, Marija Petek-Šter, Heidrun Lingner, Robert D Hoffman, Selda Tekiner, Juliette Chambe, Tamer Edirne, Kathryn Hoffmann, Enzo Pirrotta, Ayşegül Uludağ, Hülya Yikilkan, Sanda Kreitmayer Pestic, Andrzej Zielinski, Clara Guede Fernández, Birgitta Weltermann
Background. Patients use self-care to relieve symptoms of common colds, yet little is known about the prevalence and patterns across Europe. Methods/Design. In a cross-sectional study 27 primary care practices from 14 countries distributed 120 questionnaires to consecutive patients (≥18 years, any reason for consultation). A 27-item questionnaire asked for patients' self-care for their last common cold. Results. 3,074 patients from 27 European sites participated. Their mean age was 46.7 years, and 62.5% were females...
2016: Evidence-based Complementary and Alternative Medicine: ECAM
Karen L Barker, David Beard, Andrew Price, Francine Toye, Martin Underwood, Avril Drummond, Gary Collins, Susan Dutton, Helen Campbell, Nicola Kenealy, Jon Room, Sarah E Lamb
BACKGROUND: The number of knee arthroplasties performed each year is steadily increasing. Although the outcome is generally favourable, up to 15 % fail to achieve a satisfactory clinical outcome which may indicate that the existing model of rehabilitation after surgery may not be the most efficacious. Given the increasing number of knee arthroplasties, the relative limited physiotherapy resources available and the increasing age and frailty of patients receiving arthroplasty surgery, it is important that we concentrate our rehabilitation resources on those patients who most need help to achieve a good outcome...
October 13, 2016: Trials
Diana Wucherer, Tilly Eichler, Johnanes Hertel, Ingo Kilimann, Steffen Richter, Bernhard Michalowsky, Jochen René Thyrian, Stefan Teipel, Wolfgang Hoffmann
BACKGROUND: Potentially inappropriate medication (PIM) in older people is a risk factor for adverse drug effects. This risk is even higher in older people with dementia (PWD). OBJECTIVE: Our study aimed to determine (1) the prevalence of PIM among primary care patients who were screened positive for dementia and (2) the sociodemographic and clinical variables associated with the use of PIM. METHODS: DelpHi-MV (Dementia: life- and person-centered help in Mecklenburg-Western Pomerania) is a general practitioner-based, cluster-randomized, controlled intervention study to implement and evaluate an innovative concept of collaborative dementia care management in Germany...
October 5, 2016: Journal of Alzheimer's Disease: JAD
Jennifer A Price, Ana I F Sousa Soares, Augustine D Asante, Joao S Martins, Kate Williams, Virginia L Wiseman
BACKGROUND: Despite public health care being free at the point of delivery in Timor-Leste, wealthier patients access hospital care at nearly twice the rate of poorer patients. This study seeks to understand the barriers driving inequitable utilisation of hospital services in Timor-Leste from the perspective of community members and health care managers. METHODS: This multisite qualitative study in Timor-Leste conducted gender segregated focus groups (n = 8) in eight districts, with 59 adults in urban and rural settings, and in-depth interviews (n = 8) with the Director of community health centres...
September 30, 2016: BMC Health Services Research
Nefyn H Williams, Jessica L Roberts, Nafees Ud Din, Nicola Totton, Joanna M Charles, Claire A Hawkes, Val Morrison, Zoe Hoare, Michelle Williams, Aaron W Pritchard, Swapna Alexander, Andrew Lemmey, Robert T Woods, Catherine Sackley, Pip Logan, Rhiannon T Edwards, Clare Wilkinson
OBJECTIVE: To conduct a rigorous feasibility study for a future definitive parallel-group randomised controlled trial (RCT) and economic evaluation of an enhanced rehabilitation package for hip fracture. SETTING: Recruitment from 3 acute hospitals in North Wales. Intervention delivery in the community. PARTICIPANTS: Older adults (aged ≥65) who received surgical treatment for hip fracture, lived independently prior to fracture, had mental capacity (assessed by clinical team) and received rehabilitation in the North Wales area...
October 5, 2016: BMJ Open
Luísa Sá, Orquídea Ribeiro, Luís Filipe Azevedo, Luciana Couto, Altamiro Costa-Pereira, Alberto Hespanhol, Paulo Santos, Carlos Martins
OBJECTIVES: To determine, in the context of primary care preventive health services, the level of importance that Portuguese patients attribute to different preventive activities. DESIGN: Cross-sectional study. SETTING: Primary Healthcare, Portugal. PARTICIPANTS: 1000 Portuguese adults selected by a stratified cluster sampling design were invited to participate in a computer-assisted telephone survey. Persons with a cognitive or physical disability that hampered the ability to complete a telephone interview and being a nursing home resident or resident in any other type of collective dwelling were excluded...
October 5, 2016: BMJ Open
Lee A Lindquist, Rachel K Miller, Wayne S Saltsman, Jennifer Carnahan, Theresa A Rowe, Alicia I Arbaje, Nicole Werner, Kenneth Boockvar, Karl Steinberg, Shahla Baharlou
We assembled a cross-cutting team of experts representing primary care physicians (PCPs), home care physicians, physicians who see patients in skilled nursing facilities (SNF physicians), skilled nursing facility medical directors, human factors engineers, transitional care researchers, geriatricians, internists, family practitioners, and three major organizations: AMDA, SGIM, and AGS. This work was sponsored through a grant from the Association of Subspecialty Physicians (ASP). Members of the team mapped the process of discharging patients from a skilled nursing facility into the community and subsequent care of their outpatient PCP...
October 4, 2016: Journal of General Internal Medicine
Mark Orme, Amie Weedon, Dale Esliger, Paula Saukko, Mike Morgan, Michael Steiner, John Downey, Sally Singh, Lauren Sherar
INTRODUCTION: An acute exacerbation of chronic obstructive pulmonary disease (COPD) marks a critical life event, which can lower patient quality of life and ability to perform daily activities. Patients with COPD tend to lead inactive and highly sedentary lifestyles, which may contribute to reductions in functional capacity. Targeting sedentary behaviour (SB) may be more attainable than exercise (at a moderate-to-vigorous intensity) for behaviour change in patients following an exacerbation...
October 3, 2016: BMJ Open
Eliana Ferroni, Francesco Avossa, Franco Figoli, Maurizio Cancian, Cosimo De Chirico, Elisabetta Pinato, Michele Pellizzari, Ugo Fedeli, Mario Saugo, Domenico Mantoan
BACKGROUND: Hospital admissions at the end of life (EOL) represent an established indicator of poor quality of care. OBJECTIVE: To examine the impact of intensity of integrated primary and specialist home-based palliative care for chronic diseases (HPCCD) plans of care on EOL hospital access. METHODS: Retrospective population-based study using linked mortality, hospitalization, and home care data. Intensity of HPCCD was measured 90-31 days before death; outcomes were hospital death and prolonged hospital stay for medical reasons in the last month of life...
October 3, 2016: Journal of Palliative Medicine
Gregory M Garrison, Paul M Robelia, Jennifer L Pecina, Nancy L Dawson
RATIONALE, AIMS AND OBJECTIVES: Hospital readmission within 30 days of discharge occurs in almost 20% of US Medicare patients and may be a marker of poor quality inpatient care, ineffective hospital to home transitions, or disease severity. Within a patient centered medical home, care transition interventions may only be practical from cost and staffing perspectives if targeted at patients with the greatest risk of readmission. Various scoring algorithms attempt to predict patients at risk for 30-day readmission, but head-to-head comparison of performance is lacking...
October 3, 2016: Journal of Evaluation in Clinical Practice
Beverly W Henry, Derryl E Block, James R Ciesla, Beth Ann McGowan, John A Vozenilek
Literature on telehealth care delivery often addresses clinical, cost, technological, system, and organizational impacts. Less is known about interpersonal behaviors such as communication patterns and therapeutic relationship-building, which may have workforce development considerations. The purpose of this study was to conduct a systematic literature review to identify interpersonal health care provider (HCP) behaviors and attributes related to provider-patient interaction during care in telehealth delivery...
October 1, 2016: Advances in Health Sciences Education: Theory and Practice
Jared Conley, Colin W O'Brien, Bruce A Leff, Shari Bolen, Donna Zulman
Importance: Determining innovative approaches that better align health needs to the appropriate setting of care remains a key priority for the transformation of US health care; however, to our knowledge, no comprehensive assessment exists of alternative management strategies to hospital admission for acute medical conditions. Objective: To examine the effectiveness, safety, and cost of managing acute medical conditions in settings outside of a hospital inpatient unit...
October 3, 2016: JAMA Internal Medicine
Katherine E A Semrau, Julie Herlihy, Caroline Grogan, Kebby Musokotwane, Kojo Yeboah-Antwi, Reuben Mbewe, Bowen Banda, Chipo Mpamba, Fern Hamomba, Portipher Pilingana, Andisen Zulu, Pascalina Chanda-Kapata, Godfrey Biemba, Donald M Thea, William B MacLeod, Jonathon L Simon, Davidson H Hamer
BACKGROUND: Chlorhexidine umbilical cord washes reduce neonatal mortality in south Asian populations with high neonatal mortality rates and predominantly home-based deliveries. No data exist for sub-Saharan African populations with lower neonatal mortality rates or mostly facility-based deliveries. We compared the effect of chlorhexidine with dry cord care on neonatal mortality rates in Zambia. METHODS: We undertook a cluster-randomised controlled trial in Southern Province, Zambia, with 90 health facility-based clusters...
September 29, 2016: Lancet Global Health
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