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PubMed1991

Taxonomic classification of transitional follow-up care nursing interventions with low birthweight infants.

As new models of nursing care have merged, the need to understand the scope and content of nursing practice has increased. The domain of transitional follow-up nursing, an innovative model, was described by classification of nursing interventions according to the Taxonomy of Ambulatory Care Nursing. Content analysis of records of interventions employed by nurse specialists in the transitional follow-up care of very low birthweight infants yielded results that confirm the appropriateness of the Taxonomy of Ambulatory Care Nursing as a descriptor of transitional follow-up care.

Aftercare↗
PubMed2002

A study to assess patient satisfaction of transitioning from Medicaid to managed care by sickle cell patients in Hampton Roads, Virginia.

Transition issues faced by the sickle cell patient who has a significant chronic illness or disability are many and often life threatening. The problems that are faced in transitioning from Medicaid to managed care are many that could hinder the process and patient satisfaction. Such problems during the transition periods could stem from interrupted health care services; improperly coordinated services; inappropriate intervention; and inappropriate or unfounded psychologically diagnosed cases (Blum, 1993). It is not known which health care programs are cost-effective and which are not. Nor is it known which health care program best meets the needs of patients with chronic illnesses or varying levels of severity; and it is not known if health status actually improves as a result of transitioning from one program to another. What factors then impact the satisfaction levels in transitioning from Medicaid to managed care for sickle cell patients in Hampton Roads, Virginia? This study looked at patient satisfaction with the transition from Medicaid to managed care as related to the cost of care, quality of care, and access to care.

Adolescent↗
PubMed1990

A transition period in psychiatric care in Italy ten years after the reform.

Ten years after the passing of the Italian psychiatric reform bill, the author assesses the state of the national mental health services. Albeit slowly, the decrease in the number of in-patients in mental hospitals is accompanied by a numerical increase in district and out-patient services. However, the quality of care provided and the regional distribution of services are not acceptable. The reorganisation has benefited hospital and out-patient services, but community care facilities remain inadequate. The mental health of the general population seems to be unaffected by the ongoing transition in psychiatric care.

Commitment of Persons with Psychiatric Disorders↗
PubMedDate not supplied

Physician workforce planning and the transition to primary health care in former socialist countries.

With the collapse of the Soviet Union, countries in Eastern Europe and the Newly Independent States inherited a physician workforce that was often too large, dominated by specialists, and poorly prepared for the transition to primary health care and the addition of the family/general practice specialty. We examine attempts in selected countries to plan the future physician workforce, while attempting to reduce the size of the workforce and train physicians to lead the transition to primary health care (PHC). We look the impact these efforts have had on the current workforce and will have on the future physician workforce. With few exceptions, the first move after independence was to reduce the inputs into the physician workforce in an attempt to reduce the size of the workforce, considered large by western standards, in 1990 between 350 and 400 per 100, 000 population compared to the EU average of 299. These reductions often did not result from planning and ignored the lengthy physician training process, leading to concerns for the future supply of physicians and the conclusion that many other factors were influencing the number of physicians. At the same time, two methods were being employed to rapidly prepare physicians for PHC, retraining of existing physicians for the short-term and the establishment of training programs in the faculties of medicine to train family/general practitioners (GPs) for the long-term. GPs per 100,000 population remained at about 102 throughout the period in the original EU countries, but in the new EU countries went from 51 in 1991 to 63 in 2002. The success of the programs was varied and often depended on the overall organization of the physician workforce, the status of the new family physician within the workforce and the commitment at the national level to the transition to PHC. After over a decade of independence, there is still a struggle to have a physician workforce with the right numbers, the right specialty mix, and practicing in the right locations.

Education, Medical, Graduate↗
PubMed2000

Optimal strategy for management of pituitary disease in the growth hormone-deficient teenager.

The optimal treatment of chronic conditions spanning pediatric and adult clinical practice requires the establishment of clear and robust systems for managing the important period of transition of care. This principle is particularly relevant to the treatment of ongoing pituitary dysfunction after the achievement of final height and, in addition to the vital component of maintaining the confidence of the patient, encompasses a number of considerations that are particularly relevant to long-term health as an adult. These considerations include the achievement of peak bone mass, optimization of gonadal steroid and glucocorticoid replacement, and determination of the need for continuing growth hormone replacement. It is therefore necessary to consider these issues not only from the standpoint of therapeutic principles but also in the context of practical arrangements for managing the process of transition of care. Successful transition can be achieved using a variety of models, and there is clearly no single preferable option. The most important ingredient in this process is awareness of the situation by both pediatric and adult endocrinologists as well as the development of an agreed strategy within each clinical center.

Adolescent↗
PubMed1994

Easing the transition to high-tech home care.

Nurses newly employed in high-tech home care face several transitional stressors when coming from another setting. The findings of a small group study have implications in the recruitment and retention of nurses in high-tech home care.

Career Mobility↗
PubMedDate not supplied

Transitioning to adult health care facilities for young adults with a chronic condition.

Youth with chronic conditions and special health care needs are surviving into adulthood. In certain circumstances, these youth may choose to remain with their pediatricians for their health care needs. However, most youth will require complex coordinated care in order for them to live full and productive lives to the best that they are able. Issues such as independence and dependence, educational and vocational choices, and insurance are important in transitioning to an adult-focused system of health care. This article addresses strategies that will assist young adults with the process of transitioning from pediatric care centers to adult health care centers. Despite the importance of providing a transition program, few transition programs exist for young people with chronic conditions (Sawyer, Blair, & Bowes, 1997). This article will also discuss barriers to the transition process.

Adolescent↗
PubMed2006

Becoming a community matron: the transition from acute to primary care.

Community matrons are an important part of the policy of community-based management of long-term conditions. In contrast to some early conceptions of the role, community matrons can come from all areas of nursing. This article draws together two personal accounts by nurses from one primary care trust who have made the transition from acute care to community matron, and highlights the learning process they and their colleagues have undergone.

Career Mobility↗
PubMed2003

Improving geriatrics training in internal medicine residency programs: best practices and sustainable solutions.

National surveys indicate a need for additional training in geriatrics during internal medicine residencies. This paper describes 1) "best practices" for integrating geriatrics education into internal medicine residency programs, 2) barriers to implementation of these practices, and 3) possible ways to improve geriatrics training for internal medicine residents. These best practices were determined by a systematic review of the literature and through interviews with leaders of 26 residency and geriatrics programs concerned with geriatrics training for residents. The most successful programs have clinical experiences with 3 key elements: model geriatric care in 1 or more settings (for example, in the hospital or in ambulatory practice), patient care across sites or transitions of care, and interdisciplinary teamwork. Barriers include attitudes, few faculty, need for relationships with nontraditional training sites, and lack of funding. Local solutions include engaging the internal medicine program director to accomplish a mutual goal--for example, by creating a model geriatrics training experience in which residents demonstrate their skill in a new Accreditation Council of Graduate Medical Education competency (such as systems-based practice). National solutions include reaching consensus on the competencies in geriatrics that should be achieved by board-eligible internists. This may mean increasing the number of questions that test geriatrics competency in the certifying and in-training examinations, increasing numbers of faculty members able to teach and model geriatric care, developing "effective medical resident teaching" courses for nonphysician faculty, and lobbying for improved systems of care.

Curriculum↗
PubMed1994

Computerization of clinical laboratories and health care facilities: Making decisions in transition. Part I: General considerations.

In summary, it is perhaps appropriate to reflect on the transition zone that health care finds itself in now. Federally and provincially funded Royal Commission reports and health surveys over the last thirty years have all drawn a number of similar conclusions. Some of these are particularly important to keep in mind as major investments in hospital and laboratory information systems are made. First, it is known that health care providers and services are not distributed evenly throughout the country and that there is uneven utilization of services. Second, the "health" in health care is not defined in purely medical terms. Health is a function of genetic background, personal choices and behaviors like diet and exercise, socioeconomic conditions like housing, family situations, education, and employment, and the physical environment in which an individual lives and works. Governments at all levels now use this concept of health when determining policy and funding. Third, a change of emphasis has occurred from the traditional hospital-centered model to one that is community based. How well will your laboratory and facility responding to the inevitable changes to funding and consumer utilization? How well does the HIS/LIS vendor understand the circumstances affecting your organization and what agreements can be made to ensure future system support? How will an increase in profile-type testing and reflexive testing be handled to minimize disruptions to work flow and productivity? How can analytical instrument selection change the whole focus of the laboratory operation and impact on other areas? Will the traditional terms "in patient" and "out patient" still apply, or will a term somewhere in the middle evolve?(ABSTRACT TRUNCATED AT 250 WORDS)

Canada↗
PubMed2006

Smoothing things over: the transition from pediatric to adult care for kidney transplant recipients.

BACKGROUND: Transition is a planned movement of adolescents with chronic physical and medical conditions from child-centered to adult-oriented healthcare systems as opposed to a purely administrative event. OBJECTIVE: To evaluate the transition of pediatric kidney transplant recipients to the adult service at Guy's Hospital between 2000 and 2001 as compared with best practice from the literature, and to establish client satisfaction with the process. DESIGN: Data were collected by means of a retrospective review of case notes, clinician interview, and a patient satisfaction questionnaire, and analyzed by a single reviewer. MAIN OUTCOME MEASURES: Sixteen cases were analyzed with respect to their progress over the period of 1 year before and 1 year after transfer by looking at markers of adherence; a clinician's subjective assessment of overall graft stability before, during, and after transfer; and whether subjects chose to attend the transitional clinic. RESULTS: There was no qualitative difference in adherence or control among the patients who experienced the transitional clinic and those who did not. Patients who were considered stable and adherent before transition were not necessarily the same following transfer and vice versa. Patients who experienced the transitional clinic were not more satisfied as a group, although 9 of 11 thought their transition was "OK" or better. CONCLUSION: This is an extremely challenging area of pediatric nephrology; all patients need a high level of support. Services cannot be targeted to high-risk groups.

Adolescent↗
PubMedDate not supplied

Self-reported health care self-care needs of transition-age youth: a pilot study.

The purpose of this pilot study was to describe the self-reported health care self-care needs and skills of transition-aged youth referred for transition services. Data were obtained from California Healthy and Ready to Work Transition Assessment Tool through a retrospective chart review. Yes, no, and with assistance responses were rank ordered according to the sample and subgroupings of youth. Of the items, 30% were answered affirmatively by 80% or more of respondents. Nearly 20% of the items were answered as "no" by respondents. A few items were answered "with assistance" by less than 30% of respondents. Data were rank ordered according to diagnostic group. The cancer group (n=8) reported 100% "yes" responses to 12 items, compared with 2 for the developmental disabilities group (n=7) and none for the "other" group (n=10). Eight of the domains had Kuder-Richardson levels >0.60 [correction]. Spearman nonparametric correlation analyses were conducted among individual questions of the six domains with low Kuder-Richardson levels (<0.60) for further analysis and to assess the problem items. Findings revealed youth with developmental disabilities had significantly higher numbers of "no" responses in nine domains than youth with cancer [correction]. Groups were compared using domain-specific summary scores of youth with cancer diagnoses with those of youth with developmental disabilities to examine differences in level of skills. Findings revealed youth with developmental disabilities had significantly higher numbers of "no" responses in seven domains than youth with cancer. Findings revealed youth with cancer had significantly higher numbers of "yes" responses in six domains than youth with developmental disabilities. Research and clinical implications are discussed.

Adolescent↗
PubMed1995

Managed care in Iowa. A difficult transition.

On March 1, Medco Behavioral Care began managing mental health services for Iowa's Title 19 population. The state says Medco can improve access and save money, but many providers and other patient advocates have grave concerns about Iowa's first major experience with managed care.

Humans↗
PubMed2006

There to here: young adult patients' perceptions of the process of transition from pediatric to adult transplant care.

BACKGROUND: An increased understanding of the transition process from pediatric to adult transplant care may inform strategies for facilitating the transfer of patients and ultimately improve outcomes of care. OBJECTIVE: To explore the transition process from pediatric to adult transplant care from the perspective of young adults. STUDY DESIGN: Using a qualitative case study approach, data were collected from transplant recipients through organ-specific focus groups, from transplant coordinators and nurse practitioners through interviews, and from electronic documents. Data were analyzed using an editorial format. RESULTS: The analysis identified 5 elements of transition: There to Here, Getting Ready, Frame of Mind, Making It Easier, and Giving Back. In addition, threaded throughout the elements were the themes People Are Important, Expectations of Us, and Information We Need. CONCLUSIONS: The transition for young people from a pediatric to an adult transplant center can be difficult and often traumatic. Young adults who transfer to adult care need to be better prepared for the adult center, made aware of the differences, and introduced to team members before the transfer. Transition programs that aim to improve the transition process should be developed for these patients.

Adaptation, Psychological↗
PubMed2001

Strategies for improving transition to adult cystic fibrosis care, based on patient and parent views.

Although general principles guiding the transition of individuals with chronic illness from pediatric to adult care have been established, guidelines specific for the transition of individuals with cystic fibrosis (CF) have not. To aid in the development of CF-specific transition guidelines, an anonymous pretransition questionnaire and posttransition interview were used to assess the concerns and expectations of 60 CF patients and their parents as they went through the transition from pediatric to adult care. Along with demographic and clinical information, respondents were asked to rate on a scale of 1-5 their general attitude toward, or level of concern on 22 questions involving transition concerns, adult program expectations, and general view of transition. The two most important concerns identified by patients prior to transition to adult care were potential exposure to infection (3.4 +/- 1.3) and having to leave their previous caregivers (3.4 +/- 1.0). Introduction to the adult CF team prior to transition was associated with significantly lower levels of concern in all areas, particularly about having to leave previous caregivers (3.9 +/- 0.7 vs. 2.5 +/- 0.6, P < 0.004). Age, gender, severity of lung disease, and age at diagnosis were not predictive of level of concern for any area. Parents' most significant concern was ability of their child to care for their CF independently, a concern their children did not share (4.0 +/- 1.1 vs. 1.5 +/- 0.5, P < 0.0001). As their most important expectations for the adult program, patients identified ready phone access to a nurse (4.9 +/- 0.6) and education about adult CF issues (4.6 +/- 0.7). The overall attitude toward the development of an adult CF program was overwhelmingly positive for both patients (4.9 +/- 0.7) and parents (4.9 +/- 0.3). By allowing patients to interact with the adult team prior to transition and developing transition protocols which address CF-specific issues like infection control and fertility, successful transition from pediatric to adult cystic fibrosis care can be accomplished.

Adolescent↗
PubMed2001

Single-participant research design. Bringing science to managed care.

The ongoing transition to managed health care continues to have repercussions for health care providers, perhaps the most important of which is an emphasis on accountability for demonstrating the usefulness of clinical interventions. This requirement places a premium on intervention research and highlights the historically strained relationship between psychological research and professional practice. In the midst of this challenge, researchers have increasingly criticized the logic and practice of traditional null hypothesis significance testing. This article describes the history, epistemology, and advantages of single-participant research designs for behavioral scientists and professionals in clinical settings. Although its lack of correspondence with the Fisherian tradition has precluded widespread adoption, the single-participant alternative features a design power and flexibility well suited to both basic science and applied research.

Behaviorism↗