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PubMedDate not supplied

[Pharmacotherapeutic follow-up of patients in community pharmacies].

OBJECTIVE: To analyse pharmacist intervention (PI) resulting from the implementation of the Dáder Pharmacotherapeutic Follow-Up Program (PFU). DESIGN: Descriptive study of the findings from the PFU program during the first year. SETTING: Community pharmacists in area of the College of Pharmacists of the Province of Cordoba (Argentina). PARTICIPANTS: A total of 202 patients were included in the PFU, selected on the basis of the observed needs by each of the participating pharmacists. PRINCIPAL MEASUREMENTS: From the resulting PI reports the sex and age were obtained and problems related to medication (PRM) were classified according to the Second Consensus of Granada. The method of resolving PRM, the number of medications used and the number of visits made to the pharmacy to resolve each of them. RESULTS: 38 pharmacists participated and 108 patients were registered in the PI. The number of PI increased to 280, with 218 PRM resolved (77.9% effectiveness: 95% confidence interval [CI], 70.6-86.2). 25% of the PRM were resoled between the pharmacist and the patient and 75% required the participation of the doctor, the PI achieving an acceptance of 74.6% (95% CI, 67.8-82.6). CONCLUSIONS: A high percentage of resolving PRM was obtained, with a significant acceptance of the PI by the doctors, which demonstrates the feasibility of including community pharmacists in the medical team and the possibility that they could make a significant contribution in decreasing the mobility and mortality associated with medications by carrying out PFU activities.

Adolescent↗

PubMed2001

Mainstreaming palliative care for cancer patients in the acute hospital setting.

Palliative care is now emerging as an integrated part of mainstream health care delivery. The importance of patient choice regarding place of dying means that a substantial proportion of palliative care provision occurs in community settings. In part, this is due to the inappropriateness of the acute hospital setting for the care of dying patients. However, most patients with cancer and other terminal illnesses are diagnosed and treated in acute hospitals. Acute hospitals are also the most common setting where people actually die. Therefore, there remains a need for skilled and compassionate provision for the care of dying patients in the acute hospital setting. This paper presents a case for the provision of palliative care services in teaching hospitals. It further argues that a high level of integration between cancer treatment services and palliative care services is needed to optimize the care of cancer patients.

Attitude of Health Personnel↗

PubMed2002

Promoting physical activity: a profile of health plan programs and initiatives.

A study was conducted to capture information on health plans' initiatives to promote physical activity among members and in community settings. This investigation was based on a descriptive nationwide study of American Association of Health Plans- and Blue Cross and Blue Shield Association-member plans conducted from October 2001 to February 2002. Sixty individuals with responsibility for health-promotion programs were surveyed, and 24 provided in-depth interviews. The measures used in this evaluation were the number and type of member- and community-based physical activity programs/initiatives offered by health plans, and the types of programs evaluated. Information was captured on more than 373 physical activity initiatives. Thirty-five percent of surveyed health plans responded, representing more than 62 million health plan members; the participation rate for in-depth interviews was 80%. Most health plans integrate physical activity messages into routine services for members (92%) and sponsor community races/walks and health fairs (85%). Physical activity programs are offered to improve member health (92%), increase member satisfaction (80%), and reduce long-term health care costs (62%). Few rigorous evaluations have been conducted on these programs, and return-on-investment data are scarce. Although some health plans currently play a relatively active role in promoting physical fitness to their members and the community, multiple opportunities exist for health plan involvement in various settings with different populations.

Blue Cross Blue Shield Insurance Plans↗

PubMed2004

Tympanocentesis for the management of acute otitis media in children: a survey of Canadian pediatricians and family physicians.

OBJECTIVE: To evaluate the current knowledge, practice patterns, skills, and attitudes of Canadian pediatricians and family physicians regarding the role of diagnostic tympanocentesis in the management of acute otitis media in children. DESIGN: Survey. SETTING AND PARTICIPANTS: A self-completion questionnaire was mailed to a random selection of 302 pediatricians and 196 family physicians practicing in hospitals and community settings across Canada in 2002. A second questionnaire was sent to those who did not respond to the first mailing. MAIN OUTCOME MEASURES: The demographic features of respondents and their attitudes, beliefs, and behaviors regarding tympanocentesis for acute otitis media were collected via a 2-page questionnaire consisting of open-ended and multiple-choice questions. RESULTS: The overall response rate was 56%. Only 4% of pediatricians and family physicians surveyed received training in tympanocentesis, and none currently perform the procedure. Higher proportions of those who learned to perform tympanocentesis graduated from medical school before 1970 and received postgraduate training outside of Canada compared with those who did not learn to perform tympanocentesis. Pediatricians were more likely than family physicians to make referrals to otolaryngologists for tympanocentesis for acute otitis media (62% vs 48%; P = .04). CONCLUSIONS: Few Canadian pediatricians and family physicians in our survey learned to perform tympanocentesis, and none currently perform the procedure. It is not clear whether current practices for tympanocentesis in children with acute otitis media are adequate.

Acute Disease↗

PubMed2004

Strategies for increasing fruit and vegetable intake in grocery stores and communities: policy, pricing, and environmental change.

BACKGROUND: Grocery stores and community settings are important and promising venues for environmental, policy, and pricing initiatives to increase fruit and vegetable intake. This article examines supermarket-based and community environmental, policy, and pricing strategies for increasing intake of fruits and vegetables and identifies promising strategies, research needs, and innovative opportunities for the future. METHODS: The strategies, examples, and research reported here were identified through an extensive search of published journal articles, reports, and inquiries to leaders in the field. Recommendations were expanded with input from participants in the CDC/ACS-sponsored Fruit and Vegetable, Environment Policy and Pricing Workshop held in September of 2002. RESULTS: Four key types of grocery-store-based interventions include point-of-purchase (POP) information; reduced prices and coupons; increased availability, variety, and convenience; and promotion and advertising. There is strong support for the feasibility of these approaches and modest evidence of their efficacy in influencing eating behavior. Church-based programs, child care center policies, and multisectoral community approaches show promise. CONCLUSIONS: Both descriptive and intervention research are needed to develop and evaluate more effective environmental strategies to increase F&V intake in grocery stores and communities. Innovative strategies, partnerships, grass roots action involving economic development for low-income communities, and sustainability are important considerations.

Commerce↗

PubMedDate not supplied

The collaborative track option for BSN education: the best of both worlds.

As the healthcare needs of patients in acute and community settings become increasingly complex, the demand for nurses with baccalaureate and higher degrees will increase. The collaborative efforts of faculty from 1 university and 4 community colleges created a model for increasing the number of BSN graduates in 4 years. The authors describe this collaborative track model that efficiently uses the strengths and resources of both community colleges and a university for preparing baccalaureate degree nurses.

Attitude of Health Personnel↗

PubMed1996

Is the short form 36 (SF-36) suitable for routine health outcomes assessment in health care for older people? Evidence from preliminary work in community based health services in England.

STUDY OBJECTIVE: To examine the short form 36 (SF-36) health status measure when used to assess older people's views of the outcome of community based health care. DESIGN: Completion of a structured questionnaire, before and after intervention alongside in-depth interviews with a subsample of the interviewees. SETTING: Community based continence and mental health services in two health authorities in the North West Health Region. PATIENTS: Forty seven older people newly referred to mental health services or continence services between December 1992 and April 1993 participated. MAIN RESULTS: The SF-36 showed minimal change over time for both patient groups. The more detailed in-depth interviews showed that people experienced positive changes and derived value from contact with services in a number of important ways. For many reasons these benefits were not reflected in their SF-36 scores. CONCLUSIONS: The SF-36 is not likely to be the "measure of choice" for this type of evaluation, particularly where it involves older patient groups who have high levels of comorbidity. The content of the SF-36 and its lack of detail for individual assessment of change means it masks rather than illuminates patients' views of outcome.

Aged↗

PubMed2002

Experiences of problem-based learning: issues for community specialist practitioner students.

In this paper, the findings from a descriptive study exploring community practitioner students' experiences of Problem-Based Learning are presented. The study was completed as part of an extended evaluation of a core module included in a post-registration community specialist practitioner programme. Data were collected via a self-completion questionnaire. The findings identify issues relating to the learning process and its influence on the knowledge gained. They illustrate that whilst the journey taken to acquire new knowledge had been difficult for students, they had benefited from the opportunity to learn with others. The findings from this small survey are discussed in conjunction with experiential learning theory and the particular needs of students being prepared for specialist practitioner roles in the community setting where collaborative practices are increasingly understood as essential for quality care.

Community Health Nursing↗

PubMed1995

Providing intensive community support to people with learning disabilities and challenging behaviour: a preliminary analysis of outcomes and costs.

The impact of a specialist community service on the lives of three people with challenging behaviour was assessed using single-case studies. The outcome measures employed recorded changes in adaptive behaviours, challenging behaviours and staff satisfaction with the interventions used. Improvements on the behavioural measures were observed for each client, and positive feedback was received from each of the staff groups concerned. The costs of providing these interventions in community settings were calculated and compared to the costs of alternative service options.

Adult↗

PubMed1990

Psychiatry takes to the streets: the New York City initiative for the homeless mentally ill.

The authors describe New York City's program to remove seriously mentally ill homeless people from the streets to a public hospital. They report on the 298 patients hospitalized during the first year of this program. Most of the patients were male (66%), single (77%), and from outside of New York City (79%) and claimed a history of previous psychiatric hospitalization (92%) and that they had been homeless for more than 1 year (66%). Most of the patients suffered from schizophrenia (80%) and had additional medical diagnoses (73%). Follow-up contact with the patients 2 years after initiation of the program revealed that 55% of the patients either were living in a community setting or were under institutional care.

Adult↗

PubMed1985

Paradoxes faced by residents being trained in the psychosocial treatment of people with chronic schizophrenia.

The authors describe seven paradoxes that confront psychiatric residents being trained in the psychosocial treatment of chronic schizophrenic patients in community settings. The paradoxes arise because the psychosocial framework necessary for working with such patients challenges the residents' strongly held beliefs and values concerning the nature of psychotherapy and of schizophrenia. The paradoxes result in stress and resistance to learning new approaches and must be clarified and resolved for training to proceed successfully. The authors examine the origins of the paradoxes and the reactions of residents to each, and describe how the supervisory relationships of the training setting can be used to resolve them.

Adaptation, Psychological↗

PubMedDate not supplied

Developing case managers for chronically ill children: Florida's registered nurse specialist program.

This article describes the Florida Health and Rehabilitative Services/Children's Medical Services Nurse Specialist Program. This program is a statewide training and service delivery system designed to prepare selected nurses to provide comprehensive, family-centered case management services to children with special health care needs, within the home and community settings.

Child↗

PubMedDate not supplied

A comparison of clinical pediatric patient encounters in university medical center and community private practice settings.

BACKGROUND: Growing numbers of medical students complete clerkships in community private practice (CPP) settings instead of the more traditional university-based clinics, yet few empirical studies have evaluated how setting type impacts clinical experiences, skill development, and student satisfaction. OBJECTIVE: This study compared the pediatric patient encounters seen by third-year medical students in university medical center (UMC) and CPP settings. METHODS: Third-year medical students were required to keep a log of all patients seen during their 8-week pediatric clerkship. Logbook entries were coded and then analyzed for differences in the number and distribution of the primary diagnostic categories between settings. RESULTS: CPP students reported, on the average, seeing over 3 times more patients than UMC students. The case mix distribution also differed significantly by setting. In general, CPP students reported seeing proportionately more routine illnesses, whereas UMC students reported seeing proportionately more uncommon disorders. Because CPP students saw more patients overall, they averaged more cases in almost all diagnostic categories. CONCLUSION: CPP students received more clinical patient exposure than UMC students, except for patients in a few diagnostic categories.

Academic Medical Centers↗

PubMed2005

[Elimination of measles plan in the Valencia community: epidemiological surveillance in 2003].

AIMS: Describing the clinical and epidemiological characteristics of the suspicions of measles notified in the CV during the year 2003 and evaluating the system of surveillance. DESIGN: Cross-sectional, descriptive study. SETTING: Community of Valencia (CV), Spain. PARTICIPANTS: Cases of suspected measles notified in 2003. MAIN MEASUREMENTS: Description of the data collected in the questionnaires (including names) of the Plan to Eliminate Measles of the CV, and obtaining of quality indicators for this plan and those proposed in the national action plan. RESULTS: From 43 notified suspicions, 11 (25.6%) were confirmed, 29 (67.4%) discarded, and 3 (7%) compatible. The rate of effect was 0.33 of 105. From 11 confirmed cases, 10 belonged to two outbreaks (one familiar and an other one communitary) and one was an isolated and imported case. 80% of areas of health were declared. The majority of the suspicions and all the cases were given in the first half of the year. Five cases were given in cohorts of age not submitted to the program of vaccination (minors of 15 months and major of 20 years), and 2 cases might have been avoidable in agreement with the program (6 and 12-year-old children not vaccinated). 40 samples of whey and 33 of urine were collect within the recommended periods. The majority of quality indicators were over the recommended ones (80%). CONCLUSIONS: In year 2003 no case of measles has taken place from autochthonous virus in the CV.

Humans↗

PubMed2004

Outcomes after vacuum-assisted deliveries. Births attended by community family practitioners.

OBJECTIVE: To assess success rates, modes of delivery following failure, complications of mothers and newborns, and effect of extractor station and parity on vacuum-assisted deliveries attended by family physicians. DESIGN: Retrospective audit. SETTING: Community hospital. PARTICIPANTS: Thirty-five family physicians providing maternity care. MAIN OUTCOME MEASURES: Complications, parity, and extractor station of 153 vacuum-assisted deliveries from April 1, 2000, to March 31, 2003. RESULTS: Family physicians attempted 153 vacuum deliveries (82 at low station, 71 at outlet station) and had a 94.1% success rate. Of nine failed vacuum deliveries (eight at low station and one at outlet station), four were subsequently delivered by forceps and five by cesarean section. Except for one case of subdural hematoma, complications were few. Nulliparity was associated with six of the nine failed vacuum deliveries. CONCLUSION: Family physicians were usually successful with vacuum-assisted deliveries. Complications were infrequent and rapidly resolved, but one failure, which was followed by a failed forceps delivery and eventual cesarean section, resulted in a serious complication. Low station and nulliparity were associated with failure of vacuum-assisted deliveries.

Adult↗

PubMed2007

Frequency, nature and determinants of pharmaceutical consultations provided in private by Dutch community pharmacists.

OBJECTIVE: According to a report published by the federation of Dutch patients' associations, patients would like to see a pharmacist, who acts more as a personal adviser. This raised the question, how often Dutch community pharmacists have personal consultations with their patients in daily practice, on which factors this depends, and what kind of topics are discussed during these meetings. SETTING: Community pharmacies in the Netherlands. METHOD: A questionnaire was distributed among 800 randomly selected pharmacies. Questions were restricted to consultations characterized by one-to-one contact, drug therapy related content, and adequate privacy. These consultations were labelled as pharmaceutical consultations in private to distinguish them from other contacts between pharmacists and patients. MAIN OUTCOME MEASURE: Number, content, and character of consultations. RESULTS: 198 (24.8%) community pharmacies responded. The pharmacists provide an average of roughly 1.2 consultations in private per working day. The vast majority of respondents provided face-to-face and telephone consultations (94.4 and 91.9%, respectively), only a minority gave consultations by e-mail (30.8%). These consultations primarily dealt with topics related to medication safety. The mean overall time spent was 290 min per month. A relatively high frequency of personal consultations was significantly associated with the absolute number of full-time equivalent pharmacists in the pharmacy. CONCLUSION: The frequency of pharmaceutical consultations in private is low, but may be improved by reorganisation of the pharmacist's activities. The possibility of personal consultations by e-mail is not yet well-developed. Further research is needed to assess the patient's view of pharmaceutical consultations in private.

Adult↗

PubMed1998

Compliance of frail elderly with health services prescribed at discharge from an acute-care geriatric ward.

OBJECTIVES: A model of compliance by frail elderly with prescribed healthcare services was developed and tested. The discrepancy between primary care, geriatric and community health center (CLSC) services prescribed at discharge after comprehensive geriatric evaluation and treatment was measured, as were those services actually used during a 6-week interval (compliance). In this model, compliance was directly related to elders' intention to adhere to prescribed services, but this relationship was modified by organizational factors, reinforcing factors, and changes in health status during the observation period. Intention to adhere resulted from individual and reinforcing factors existing before discharge. METHODS: This model was tested on 211 patients discharged to community settings from an acute-care hospital geriatrics ward. Information was obtained through interviews with the patients or care givers and from hospital, outpatient, and local community health center charts. RESULTS: On average, patients used 56.9% of services prescribed; 13% of patients did not use any of the services prescribed for them, whereas 22% used all the services prescribed. Intention to adhere was influenced by patients' perception of the benefits of prescribed services and by their perception of the ease of access to transportation. Intention itself was not found to be an important determinant of overall compliance. Among organizational factors, having the ward staff make a follow-up appointment with the patients' family doctor and with the geriatric clinic before discharge and communication with the local community health center increased overall compliance. Moreover, patients who perceived they had access to transportation and to an accompanying person were more likely to comply. CONCLUSIONS: The results suggest that when discharging patients to the community, steps taken for them by the discharging healthcare providers will improve compliance.

Aged↗

PubMed1997

Reform and reshaping mental health services in the Montreal area.

Over the past 40 years, the mental health care system has been radically transformed from one focused on institutionalized care to one centred on treatment in community settings. Following the example of the UK and USA, Quebec is travelling down a similar path in transferring mental illness services from mental hospitals to the community. The purpose of this present study is firstly to examine why and how this administrative settlement has been reached; secondly to explain the operation of the service, especially in both sectors where Quebec has innovated: family housing and individualized service plans.

Case Management↗