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At least 649 records · Page 36Linked to original sources
PubMed1999

Transition from paediatric to adult care for persons with cystic fibrosis: patient and parent perspectives.

OBJECTIVES: To gauge the perspectives of adolescents and adults with cystic fibrosis (CF) and their parents regarding the transition from paediatric to adult-oriented health care. METHODS: Cross-sectional survey using an anonymous, semi-structured questionnaire. The study population consisted of adolescents and adults attending a paediatric and an adult CF clinic in Cape Town, South Africa and their parents. RESULTS: Forty-seven of the 61 subjects completed the questionnaire (response rate 77%). Autonomy in health care was 'extremely important' to most persons with CF. Transfer at the age of 16-18 years of age was the preferred option for most respondents. Whereas over 80% of parents felt their children needed more CF-related information, only 38% of adolescents expressed this need (P < 0.05). Adolescents also reported little need for general health information. More than 80% of respondents were 'unsure' about transfer. Over 90% felt that a transition clinic would be useful. As viewed by the respondents, its main purpose would be to provide information about the adult clinic and an opportunity to meet the CF doctor in the adult clinic. CONCLUSION: There are significant concerns about the transition process in this population. Given the expressed need for autonomy and a transition clinic, the basis for a smoother transition in the future has been laid.

Adolescent↗
PubMed2001

Clinical governance and professional restratification in general practice.

Examines the professional stratification in general practice in the UK National Health Service. Looks in particular at the reforms implemented by New Labour--the introduction of primary care groups and their transition to primary care trusts. Concludes that the key to restratification lies in understanding the agenda being pursued.

Efficiency, Organizational↗
PubMed2004

Cancer follow-up care in New Brunswick: cancer surveillance, support issues and fear of recurrence.

The purpose of this study was to find out, from the patient's perspective and using qualitative methodology, how cancer follow-up care is managed in a New Brunswick health region. From focus group discussions with 23 participants 1-year post-cancer diagnosis, 3 prominent themes emerged: fear of recurrence, cancer surveillance/testing and support issues. The fear of recurrence permeates day-to-day life for many patients. To allay these fears, some patients feel a need to be subjected to extensive cancer surveillance. Emotional support, which is important for survivors, is complex. The majority of the participants in this study received cancer follow-up care from specialists. More rural than urban participants received their follow-up care from their family physicians (FPs). Participants had high expectations for follow-up care, regardless of which type of physician--specialist or FP--provided it. If physicians did not provide the level and intensity of care expected by their patients, they were considered uncaring. We advocate a "transition of care" or "shared care" protocol between the acute cancer treatment provider and the FP, particularly in rural areas. This would ensure that cancer patients have a clear understanding of where to turn for ongoing surveillance, when they fear cancer recurrence or need support. For optimized cancer follow-up care, physicians must be cognizant that careful emotional and clinical management over an indefinite period of time is required, and they must recognize the individual needs of each patient.

Adult↗
PubMed2005

In search of financial viability: hospital-based v. freestanding home care.

In the continually changing and perpetually unpredictable nature of Medicare and Medicaid reimbursement, many hospitals and health care systems are rethinking their relationships with their affiliated home care and hospice programs. As the books of many of these programs show an increasing amount of red ink, many hospitals are spinning off their home care and hospice services into independent entities with their own individual operating structures. This article provides insight into one health care system's transitioning of its home care services into a freestanding entity.

Home Care Services↗
PubMed2003

Using information technology to improve the health care of older adults.

The high burden of illness and frailty common among our growing population of older adults often results in fragmentation of care across providers and health care systems, increasing the complexity and costs of caring for these patients. Information technology offers one way to meet this challenge. Scientists at the Regenstrief Institute have more than a quarter-century of experience in using medical informatics to support clinicians in the day-to-day care of older adults. Their research has progressed through several evolutionary cycles, beginning with the acquisition of relevant data and moving to studies of the most efficient and effective mechanisms that bring information to bear at the time of clinical decision making. Information technology designed with the input of the end user has the greatest promise of changing provider behavior because it balances technological challenges with the cultural context of the practice environment. One topic of active research is information technology to support transitions of care among sites and providers. These transitions place older adults at increased risk for avoidable illness, death, and health care costs. Information systems that improve communication among providers during these transitions have the potential to improve safety and reduce costs.

Aged↗
PubMed2000

Breaking bad news in the transition from curative to palliative cancer care--patient's view of the doctor giving the information.

In the transition from curative to palliative cancer care, communication is of special importance. The aim of this study was to explore how patients with a disseminated cancer disease experienced the information about their incurable state, focusing on the physician. The persons taking part were 30 patients admitted to a hospital-based home care unit in Sweden. Semi-structured interviews were conducted and analysed using a qualitative method. All patients described their doctors as experts, despite different qualities. Six subcategories were identified: (1) the inexperienced messenger, (2) the emotionally burdened, (3) the rough and ready expert (4) the benevolent but tactless expert, (5) the "distanced" doctor and (6), the empathic professional. The relationship was described as very important to the patients' capacity to handle the information and was felt to have been built up during earlier meetings. The relationship was described in four subcategories: personal between well-acquainted individuals, impersonal between unacquainted individuals, personal between unacquainted individuals and impersonal between well-acquainted individuals. Both the character of the physician and his or her ability to create personal relationships influence patients' capacity to cope with this specific situation. Education and guidance are needed both in clinical practice and in medical schools.

Adult↗
PubMed2005

Transition planning for youth with special health care needs: results from the National Survey of Children with Special Health Care Needs.

OBJECTIVE: To describe the proportion of youth with special health care needs (YSHCN) who are receiving services for medical transitions and to describe which sociodemographic and health care-related factors are associated with receiving transition services. METHODS: We analyzed responses to questions about medical transitions from the 2001 National Survey of Children With Special Health Care Needs (NS-CSHCN). Parents or guardians of youth aged 13 to 17 years who screened positive for the survey were asked (1) whether they had discussed with health care providers how their child's health care needs might change in adulthood, (2) if they had a plan to address these changing needs, and (3) if their child's health care providers had discussed having their child eventually see a doctor who treats adults. Bivariate and multivariate associations were estimated to identify sociodemographic and health care factors related to receiving medical-transition services. RESULTS: Overall, 50% of respondents had discussed their child's changing health care needs with their physicians, although significantly fewer Hispanic youth compared with other youth reported these discussions. Youth who met criteria for a medical home were more likely to have discussed changing needs and to have a plan addressing these needs. Of those who had discussed changing needs, 59% had a plan to address these needs and approximately 42% had reported discussing shifting care to adult-oriented providers. Younger teens and non-Hispanic black children were less likely to have discussed changing providers. Fifteen percent of YSHCN met the Maternal and Child Health Bureau's core outcome for medical transitions. A multivariate logistic-regression model found that older age and having a medical home were significantly associated with increased odds of meeting the outcome measure. CONCLUSION: The proportion of YSHCN meeting the medical-transition outcome measure is quite low, particularly for youth from ethnic minorities. Higher rates are seen for older teens and those receiving care within a medical home. Significant efforts will be required to meet the proposed goal of all YSHCN receiving the services necessary to transition to adult health care.

Adolescent↗
PubMed1975

Brief hospitalization of patients with families: initial results.

A total of 175 newly admitted inpatients who lived with families were randomly assigned to three treatment groups: standard inpatient care (discharge at the therapist's discretion), brief hospitalization (one week or less) with transitional day care available, and brief hospitalization without day care. Outpatient aftercare was offered to all patients. The three groups showed no significant differences as to amount of improvement in levels of psychopathology at 3 and 12 weeks, but the briefly hospitalized patients were able to resume their vocational roles sooner. There were no significant differences among the groups in readmission rates.

Adolescent↗
PubMed1976

Brief versus standard hospitalization: the families.

A total of 175 newly admitted inpatients who lived with families were randomly assigned to three treatment groups: standard inpatient care (discharge at the therapist's discretion), brief hospitalization (one week or less) with transitional day care available, and brief hospitalization without day care. Outpatient aftercare was offered to all patients. There was no major differential family burden as a function of length of hospitalization. Generally, brief hospitalization had several positive effects on family functioning, primarily earlier resumtption of occupational roles and less financial burden, with few significant deleterious effects.

Adult↗
PubMed2003

Psychiatric care of suicides in Hong Kong.

BACKGROUND: Though psychiatric patients have high suicidal risks, relatively little is known about the pattern of psychiatric care they received, especially in a non-Western setting. METHODS: Territory-wide record linkage study of computerised psychiatric records of suicide cases according to coroner's verdicts. RESULTS: Only 1/4 of the suicide population received psychiatric care in Hong Kong. These patient suicides differed from general population suicide in the distribution of sex, age, and suicide methods. Suicides are more common during the periods of in-patient care and immediately post discharge. Among these patient suicides, recent contacts with psychiatrists before their lethal acts were common. LIMITATIONS: Proportion of patients that received psychiatric care could be underestimates because private psychiatric patients and persons who immigrated were not counted. No clinical data are available from the record linkage. CONCLUSIONS: A wider coverage of psychiatric care to the suicidal population is required through improved accessibility and public health education. A smooth transition of care after discharge, active case tracing, and improved in-patient care should be considered.

Adolescent↗
PubMed1998

Caring for patients at the end of life in an HMO.

BACKGROUND: Increasing numbers of Americans are receiving care within managed care organizations (MCOs), and the ability of MCOs to provide high-quality end-of-life care is under greater scrutiny. Although many anecdotal reports have been published, almost no research has been published on patient/family experiences with end-of-life care in MCOs. METHODS: We undertook a qualitative study of end-of-life care during 1996 and 1997 in the closed-panel staff-model, not-for-profit, health center division of Harvard Pilgrim Health Care. We collected and analyzed data from five focus groups composed of family members of patients who had died during the preceding year (n = 22) and four focus groups composed of clinicians and administrators who routinely care for dying patients and/or have responsibility for managing end-of-life care resources and systems (n = 31). RESULTS: Problems noted in this setting that are also reported in other health care settings included divergent expectations and unclear primary care/specialist roles and hospice/primary physician roles, difficulties in transitions across care settings, ineffective communication between physicians and patients/families about end-of-life care preferences, and lack of systematic attention to bereavement care. More unique to managed care settings were problems related to the absence of a consistently applied hospice benefit and concerns about the impact of cost containment on the quality of care, reflecting the conflict between the dual roles of MCOs as both insurers and providers of care. CONCLUSIONS: Our findings highlight specific issues involved in providing quality end-of-life care in MCOs and suggest areas for further exploration.

Journal Article↗
PubMedDate not supplied

Does amount of time spent in child care predict socioemotional adjustment during the transition to kindergarten?

To examine relations between time in nonmaternal care through the first 4.5 years of life and children's socioemotional adjustment, data on social competence and problem behavior were examined when children participating in the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care were 4.5 years of age and when in kindergarten. The more time children spent in any of a variety of nonmaternal care arrangements across the first 4.5 years of life, the more externalizing problems and conflict with adults they manifested at 54 months of age and in kindergarten, as reported by mothers, caregivers, and teachers. These effects remained, for the most part, even when quality, type, and instability of child care were controlled, and when maternal sensitivity and other family background factors were taken into account. The magnitude of quantity of care effects were modest and smaller than those of maternal sensitivity and indicators of family socioeconomic status, though typically greater than those of other features of child care, maternal depression, and infant temperament. There was no apparent threshold for quantity effects. More time in care not only predicted problem behavior measured on a continuous scale in a dose-response pattern but also predicted at-risk (though not clinical) levels of problem behavior, as well as assertiveness, disobedience, and aggression.

Affect↗
PubMed1992

Transition program from pediatric to adult care for cystic fibrosis patients.

A survey of adolescents and young adults with cystic fibrosis (CF) attending an adult CF center was conducted to evaluate a transition program as a means of transferring care from pediatric to adult setting. A total of 40 patients completed a self-administered questionnaire of whom 13 (32.5%) went through the transition program, and 21 (52.5%) received their care at the University of Michigan Cystic Fibrosis Center. Fourteen patients (35.0%) were cared for at other pediatric CF centers, and five (12.5%) were first diagnosed as adults. All those in the transition program approved of having the visit with the internal medicine physician in the pediatric clinic. Most thought that the transition program made the change from pediatric to adult care easier. All patients were comfortable leaving the pediatric clinic after the transition period. Of the 40 patients, 17 (42%) recommended that other patients go through the transition program, although 9 of these 17 patients did not themselves go through the transition program. Twenty-six patients (65%) preferred the adult program. These findings suggest that adolescents with CF should be encouraged to transfer their medical care to an adult CF Center once they have reached an agreed-upon age. This process should be smooth and should occur as part of the regular CF care. This is possible through a well-structured and well-organized transition program with committed pediatric and adult staff.

Adolescent↗
PubMed1999

Trends in transition from pediatric to adult health care services for young adults with chronic conditions.

PURPOSE: The rationale underlying this study was the need to move the transition health services model from a theoretical framework to an empirically-based investigation. Thus, it was necessary to identify programs for youth with chronic or disabling conditions that assist in transitioning from child- to adult-focused health services by (a) discrete types, (b) functional categories, and (c) problems and issues faced by these programs. METHODS: Nominations for transition health services programs were solicited from 1025 organizational agencies at the local, state, regional, and national levels. Two solicitations yielded 277 nominees. After pilot testing, a survey of 163 forced responses and open-ended questions was mailed to each nominated transition health services program. A total of 122 programs returned completed surveys. RESULTS: Program services were categorized as adolescent-focused (38%), condition-focused (36%), and specialty-specific programs (26%). Few programs were primary care-based. Categories were subsequently collapsed into two types: adolescent-focused and condition-focused. No significant differences were noted between adolescent- and condition-focused programs regarding provision of mental health services, vocational counseling, self-efficacy training, or health education. The primary barriers to transition health services were identified as funding and access to key staff, rather than family and adolescent resistance. CONCLUSION: In general, self-identified transition health care programs do not achieve the goal of collaborative, coordinated, and integrative services to adolescents with chronic or disabling conditions. Furthermore, the barriers to attaining the goal are the limitations of the health care system itself.

Adolescent↗
PubMed2006

The adolescent with a chronic illness.

The primary care clinician can play an important role in enhancing the quality of life for the adolescent with chronic illness through developmentally appropriate, individualized and compassionate coordination of care (Sidebar 2). Special attention to the process of adolescence, family, and psychological issues are required for successful management. Transition of care to adult services should be planned carefully with a multidisciplinary team.

Adaptation, Psychological↗
PubMed2005

Pressure ulcer prevention and care: preventing and managing pressure ulcers in long-term care: an overview of the revised federal regulation.

Although the Centers for Medicare and Medicaid Service's Federal Regulation as it relates to pressure ulcer prevention and care in long-term care facilities has not changed, the Guidance to Surveyors (F-314) has been expanded significantly. In addition to more clearly defining commonly used terms, the new guidance document emphasizes the use of pressure ulcer risk assessment and prevention strategies, pain assessment and treatment, and monitoring the care outcomes. The Centers for Medicare and Medicaid Service has clearly raised the bar on pressure ulcer care. Based on currently available evidence, the guidance document is clear in its intent to encourage all long-term care facilities to adopt evidence-based pressure ulcer protocols of care. This transition, and the development and implementation of this guidance document, may present considerable challenges to some long-term care facilities. However, the lack of ambiguity in the F-314 document and its consistency with currently available evidence may be helpful to staff and improve outcomes of care.

Humans↗