PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Transitional Care”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 397 records · Page 22Linked to original sources
PubMed2004

Providers' perspectives and beliefs regarding transition to adult care for adolescents with sickle cell disease.

Until recently, few children with chronic illnesses such as sickle cell disease (SCD) lived past late adolescence. Substantial reductions in mortality mean a growing number of adolescents with SCD reach adulthood. Consensus among researchers and health care providers (HCP) from multiple disciplines is that critical attention to and more empirical research on the transition from pediatric to adult care is needed. We address the following questions: (1) How do pediatric and adult providers demonstrate involvement in transition? (2) What is expected of adolescents when they move to adult care? and (3) Do providers think there is a need for a systematic transition program? A cross-sectional, multi-format survey research study utilizing open-ended and forced-choice questions was conducted to compare responses between pediatric and adult providers from multiple disciplines. Data were collected from 227 HCP in three waves. Significant bivariate results (p < 0.05) reflected differing opinions regarding transition expectations and program need, especially among female providers, those practicing in urban areas, and providers who treat both adolescent and adult clients in comparison with their counterparts. Discussion includes implications for program development, social service and public health practice, and future research.

Adolescent↗
PubMed2002

Transitions to informal care in Great Britain during the 1990s.

OBJECTIVES: To estimate annual changes and trends in the population of informal carers and to investigate transitions to caregiving by age, gender, locus of care, and level of involvement. DESIGN: Longitudinal analysis of data from the British household panel survey, 1991 to 1998, an annual prospective survey of a nationally representative sample of more than 5000 private households in England, Scotland, and Wales. SUBJECTS: Over 9000 adults over 16 years interviewed personally in successive waves of the survey, including around 1300 informal carers each year. RESULTS: One third of co-resident carers and 40% of extra-resident carers start caregiving each year and similar proportions cease to provide care. Five year period rates are at least 75% higher than the one year prevalence estimates. Almost everyone is involved in caregiving at one time or another and over half are likely to provide 20 hours or more care per week at some point in their lives. Recent trends indicate that more adults are becoming heavily involved in providing longer episodes of care. Although the onset of caregiving peaks in late middle and early older age, above average incidences span three decades or more of adult life. Age variations in the start of caring relationships are driven by the changing demands for care within and between generations over the life course. There is no firm evidence that carers increase their involvement in caring activities over the first three years of a caring episode. CONCLUSIONS: The population of carers is constantly changing as some people stop providing care and others take on a caring role or vary their level of involvement. Policy measures responsive to the diversity of caring roles, and geared around key transitions, are likely to be most effective in supporting carers through changing circumstances. Recognition and support for carers who are heavily involved in caring activities from the outset should be a priority.

Adolescent↗
PubMed2000

Adolescents with special health care needs in transition: three life histories.

PURPOSE: This study was part of a large multi-method inquiry designed to examine the service and support needs of adolescents with special health care needs who are transitioning to adulthood. METHODS: A multiple case study methodology relying on life history was used to ascertain perspectives of the parents on the longitudinal events and factors in the lives of adolescents with special health care needs that shaped or currently influence adolescent transition to adulthood. Three informants were purposively selected to depict a range of health and socio-economic conditions. Long interviews were conducted and audiotaped and transcribed data were thematically and taxonomically analyzed. RESULTS: Six major themes emerged in the analysis: (1) Begetting a service system, (2) Pathology or not pathology, (3) Educational stability vs. interruptions, (4) Role blurring of parents and providers, (5) Private life made public, and (6) Independence vs. burden. CONCLUSIONS: The study revealed that, consistent with the literature, adolescents with special health care needs do not follow typical developmental sequences, although their needs and desires are no different than those of typical adolescents. The lives of the adolescents and their families are significantly influenced by the timing and nature of the diagnosis, the family's articulation with service providers, and the degree to which school systems are responsive to atypical adolescents. Implications for health providers and future inquiry are advanced.

Adolescent↗
PubMed2006

[Essentials for transition of palliative care patients to palliative home care and for management of their cancer pain].

Multi-disciplinary team work among visiting doctors, nurses, care managers and pharmacists located close to the patient's home is essential for smooth transition of a palliative care patient from hospital care to palliative home care and should be set up prior to the patient's discharge from the hospital. Palliative home care physicians should have knowledge of the fundamental support by the government to spare excessive cost to the patients. As for cancer pain management, opioid-centered analgesic therapies have lead to better quality home care for patients. In Japan, although oxycodone SRs and fentanyl patches are available besides morphine, there is no rescue opioid other than morphine. On the other hand, some cancer pain refractory to opioids such as neuropathic cancer pain should be carefully treated by adjuvant analgesics in conjunction with non-pharmacological treatments.

Analgesics, Opioid↗
PubMed2002

Rationing of expensive medical care in a transition country--nihil novum?

This article focuses on rationing of expensive medical care in the Czech Republic. It distinguishes between political and clinical decision levels and reviews the debate in the Western literature on explicit and implicit rules. The contemporary situation of the Czech health care system is considered from this perspective. Rationing reoccurred in the mid 90s after the shift in health care financing from fee-for-service to prospective budgets. The lack of explicit rules is obvious. Implicit forms of rationing, done by physicians at the clinical level prevail, implying uncontrolled power of the medical profession and lacking transparency for ethical considerations of equity to access. It seems to be acceptable for physicians to play the role of allocators, probably because of their experience with rationing during the socialist period. Traditional rationing stereotypes from the previous regime seem to persist despite the health care system transformation during the 90s.

Czech Republic↗
PubMed2006

Changes in primary health care centres over the transition period in Slovenia.

BACKGROUND: Primary health care centres (PHCCs) were a characteristic of the former Yugoslav health care system introduced widely in Slovenia. Transition brought structural changes to health care and the position of the PHCC's was challenged. This paper investigates (i) PHCCs' perception of transition changes in health care, (ii) changes in resources and services, and (iii) changes in the relationships between PHCCs and new primary health care providers. METHODS: We mailed a self-administered questionnaire with 42 questions divided into 8 chapters and related to the period between 1990 and 2000 to all 65 PHCCs in Slovenia. Questions were of three types, grouped according to the aspects we were trying to explore: perceived changes, actual changes and relations with new providers. RESULTS: We obtained 57 questionnaires representing PHCC catchment areas covering 93.7% of the Slovenian population. Municipalities' position versus PHCCs was reinforced but their role remains ambiguous. The number of employees was reduced by one third, capital investments are still ongoing, but the scope and volume of services has shrunk. Relations with the Health Insurance Institute of Slovenia (HIIS) were considered controversial while the influence of the public providers' association is perceived as marginal. CONCLUSIONS: PHCCs have survived the transition both structurally as well as functionally. However, an unstructured approach to system changes in primary care, a poorly managed process of introducing private provision, and a monopoly position of the HIIS affected their situation. The challenges for the future will be in preserving their public health functions, in increasing efficiency and in establishing clearly defined relations with private providers.

Forecasting↗
PubMed2003

As the child with chronic disease grows up: transitioning adolescents with special health care needs to adult-centered health care.

The purpose of this article is to inform readers of the Delaware Medical Journal about the concept of transitional care for adolescents and young adults with chronic health care needs. This is a topic that has recently received national attention and was the subject of a supplement to Pediatrics in December 2002. The concept of transitional care bears special importance in Delaware as every year hundreds of children with chronic disease turn 18 and leave their pediatric providers. It is uncertain that these children resume their care with an adult health care provider, and there is almost always some lag in time as patients attempt to find an adult provider who is knowledgeable about their condition and willing to assume them as a patient. An even greater uncertainty is whether or not adult providers are prepared to take care of this new generation of adults with cyanotic congenital heart disease, spina bifida, cerebral palsy, and other conditions. This article explores some of these ideas and discusses what is available in the transition literature and where to go from here.

Adolescent↗
PubMed2005

German health care system in transition. The difficult way to balance cost containment and solidarity.

As is the case with all other health care systems, the German one is in constant transition. The reasons--such as costly medical innovations, aging population, and lack of overall economic growth--are well known, widely discussed, and not unique to Germany. Although the problems are not unique to Germany, there are some trends in each country which may be of interest to other countries. This contribution provides an update on the German health care system and reports current reform trends.

Advisory Committees↗
PubMed2003

Transitioning youths into care: linking identified HIV-infected youth at outreach sites in the community to hospital-based clinics and or community-based health centers.

PURPOSE: To describe and analyze the process of transitioning HIV-infected youths from the point of HIV diagnosis into HIV treatment. Rather than simply offering HIV positive youths a list of referrals, the youth-focused SPNS grantees (AWAC) found it vital that youths were immediately assisted with linkage to a medical provider. METHODS: From February 1997 to December 2000, 107 identified HIV-infected youths from the five adolescent SPNS projects were surveyed on needs and barriers. The time interval between HIV testing and youth linkage to care was also noted. RESULTS: Nine percent of youth reported perceived barriers to accessing health care. Perceived needs were identified as Mental Health (44.9%; n = 48); Alcohol and drug treatment (14%; n = 15); transportation to health care settings (40.2%; n = 43); and housing (46.7%; N = 50). At sites tracking linkage to care, the time of being transitioned into a medical setting ranged from 5 to 55 days (average 26 days). CONCLUSIONS: The period of transitioning identified HIV-infected youths into care can be reduced from 1-5 years to as short as 5-55 days. Success with linking these youth to care involves establishing a series of contacts at outreach sites wherein program staff seeks to build trusting relationships with youths, is able to track these youths and identify and address perceived needs.

Adolescent↗
PubMed2000

Primary health care system in transition: the patient's experience.

OBJECTIVE: To find out how Estonian people evaluate the changes in primary health care (PHC), how they perceive the acceptability of the new PHC system, and to assess patients' satisfaction with their primary care doctor. DESIGN: Face-to-face interviews using structured questionnaires. SETTING: Estonia. STUDY PARTICIPANTS: A random sample of Estonian residents aged 15-74 years (n = 997). MAIN MEASURES: Acceptability of PHC system (accessibility, the patient-practitioner relations, amenities, and patient's preferences) and patients' satisfaction with primary care doctor. RESULTS: Of the 997 respondents, 46% were sufficiently informed about the transition to the general practitioner (GP)-based PHC system; however, 45% of respondents had not personally experienced any changes. Of the 997 persons interviewed, 68% were registered on the patient list of a GCP, and 62% of those who had health problems preferred to consult the primary care doctor first. The waiting time for an outpatient appointment was brief (0-2 days). Of the 997 respondents, 68% were satisfied with their primary care doctor. Satisfaction was dependent on: (i) how patients evaluated the competence of the physician; (ii) comprehensibility of doctor's explanations; and (iii) comfort of the clinic. The right of patients to choose their own primary care doctor and having sufficient information about the changes in PHC system had a positive influence on the level of satisfaction. CONCLUSIONS: Patients' opinions are important in the evaluation of PHC. To increase the level of satisfaction, people need to understand the nature and intent of the primary care reforms. Personal choice of primary care doctor and good patient-doctor relationships are important factors too.

Estonia↗
PubMed2005

[Decisions around the end of life on Intensive Care: making the transition from curative to palliative treatment].

The decision to move from curative treatment to palliative care in the intensive-care situation is less related to morals and ethics than it is to the assessment of medical issues, professionalism, communication and orchestration. Treatment should be considered medically pointless if, in the view of the treating physicians, it does not offer realistic chance to return to a meaningful life. Continuing futile care can be seen as disrespectful, both to the patient, his partner and the family, as well as to the members of the ICU team. Intensivists are responsible for withholding or withdrawing life support to patients in whom further life support is considered futile and who are unable to express their wishes due to critical illness and sedation. The intensivist typically makes this type of decision after a period in which medical and other information has been collected and after intensive discussions with other medical professionals as well as the partner and family. This is based on the trust that is built up through their skill, attitude and behaviour and that is perpetuated in a continuing process of intensive communication. Conflicts should be prevented, or at least recognised early and discussed. Ifa conflict is ongoing then it should be tackled by planning a number of consecutive consultations.

Decision Making↗
PubMed2001

Transition to home care after stroke: depression, physical health, and adaptive processes in support persons.

A longitudinal design was used to examine adaptation in primary support persons (PSP) of stroke survivors during the transition from hospitalization (T1) to home care (T2). The major purposes of the study were (a) to examine changes in depression, physical health, and contextual and coping factors from hospitalization of the stroke survivor through the first 6-10 weeks of home care; and (b) to identify predictors of depression. Data (N = 136) were collected on depression, physical health, background, survivor illness, and social environmental variables; appraisal of impact; social support resources; and coping skills. Reduction in mean PSP depression was significant at T2, but the change in physical health was not significant. Significant changes occurred in survivor function, family functioning, and three of six coping skills. Hierarchical multiple regression analyses were used to predict depression. T1 variables accounted for 29% of the variance in T1 PSP depression, with gender and appraisal of impact the strongest of seven predictors. T1 depression, T2 health, family functioning, and avoidance coping were the strongest of seven predictors, explaining 50% of the variance in T2 depression. Findings highlight the importance of maintaining caregiver health and preventing depression and identify variables to target for the reduction of PSP depression.

Adaptation, Psychological↗
PubMed2005

Transitions and shifting goals of care for palliative patients and their families.

Terminally ill patients and their families experience many confusing and, at times, traumatic transitions. Examples of such transitions include transitions from cure to comfort care, transitions related to loss, changes in care settings, and psychosocial and spiritual transitions. The purpose of this article is to discuss the experiences of palliative patients and their families as they journey through transitions and how oncology nurses can provide support. Using a composite case study from actual clinical cases as a framework for discussion, the authors present examples of evidence-based strategies that can be used by oncology nurses. Critical points from the case study are Adjustment to death is a process and cannot be rushed. The needs of a palliative patient and family should be heard, honored, and not questioned or challenged. A patient and family should remain in control of decision making, with the hospice and palliative care team acting as guides and facilitators.

Family↗