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At least 19 recordsLinked to original sources
PubMed1996

Application of primary health care standards to a developing community health group: a rural case history.

The development of community health groups in rural settings involving private general practitioners and other health care workers has been relatively rare. This case history examines the activities of such a group and the views of its participants over a 12-month period. It considers whether the principles of primary care and the relevant Community Health Accreditation and Standards Program criteria can be applied in such a setting. The centre was able to meet most of the primary care criteria; however, some other important elements that could be helpful to further developments emerged in the research process. These included the sensitivity of a rural community to an individual case or patient focus in a case conference setting and the high level of acceptance of population or healthy-community goals. Other key issues included the strength (in terms of advocacy for health service provision) of an intersectoral group in a rural setting. Positive benefits were perceived to accrue from the increased professional and intersectoral communication. The role of the private general practitioner was focal, but the participants did not believe this necessarily had to be a leadership role. The initiation of such a conference and its leadership could be undertaken by any interested and appropriately skilled member. Organisation, administration, continuity and cost are important practical issues which need to be examined in early stages of development and taken into account in evaluation.

Accreditation↗
PubMed1995

The structural quality of Tanzanian primary health facilities.

Structural quality is a key element in the quality of care provided at the primary level, which aims to offer health care interventions of proven efficacy. This assessment of the structural quality of Tanzanian primary health services indicated serious weaknesses in the available physical infrastructure, as well as supervision and other support, both for government and nongovernmental services and for dispensary and first referral-level services. Addressing these weaknesses is likely to require some additional funding and review of the functions of different groups of health care facilities within the primary care system. Although district health management teams have an important role to play in tackling the weaknesses, the existing division of management responsibilities indicates that they can only do so with the support of the regional and national levels of the health management structure. Study methods might be adapted to facilitate improved supervision and management.

Catholicism↗
PubMed1993

Australian Community Health Association Practice Standards and their application for primary health care in Papua New Guinea.

This paper describes the Australian Community Health Association Practice Standards (CHASP) and their application in the CHASP review process as a model that could be emulated to improve the quality of primary health care delivery in Papua New Guinea. The characteristics which could be beneficially emulated in Papua New Guinea are the comprehensive nature of the standards and their wide applicability, the balance contained in their development and application between the inputs of technical expertise and local involvement, and the structured nature of the CHASP review process itself. A model is proposed of how the CHASP standards and review process could be fruitfully used in Papua New Guinea to improve the quality of rural health care delivery.

Australia↗
PubMed1994

Development and evaluation of a Computer-Assisted Management Protocol (CAMP): improved compliance with care guidelines for diabetes mellitus.

Disease-specific standards for directing patient management are becoming increasingly important. These standards, however, are often not followed because they are not sufficiently integrated into the clinical care setting. In this study we describe the development and evaluation of a Computer-Assisted Management Protocol (CAMP) of care guidelines for diabetes mellitus. While other studies have shown improved compliance with rule-based reminders, the CAMP customizes disease-specific care guidelines to individual patients over time. We evaluated the effect of the CAMP on compliance with guidelines in a prospective, randomized controlled study. The study was performed at a family practice clinic where much of the patient record is maintained electronically on The Medical Record (TMR). The management protocol was developed from standards published by the American Diabetes Association. Fifty-eight providers were randomized to either receive or not receive the CAMP for diabetes. Compliance with standards was assessed by chart audits of all encounters with diabetic patients during the study interval. The following conclusion was made: the Computer-Assisted Management Protocol resulted in a statistically significant improvement in compliance with diabetes care standards.

Diabetes Mellitus↗
PubMed1998

Reducing thrombolytic therapy time delays in the emergency department.

A 1 year (1995) retrospective audit of all patients who were discharged or died, with a primary diagnosis of acute myocardial infarction (AMI) was conducted at Auburn Hospital, a level 4 district hospital in Sydney's western suburbs. After their first echocardiogram (ECG), 21 patients of 129 patients who had a primary diagnosis of AMI in the Emergency Department at this time were given thrombolytic therapy. For eight patients there was a time delay of over 60 min to commencement of thrombolytic therapy. This time delay exceeded the Australian Council of Health-care Standards guidelines and was targeted as a quality improvement activity. The hospital cardiologist convened meetings of medical and nursing staff, to develop an action plan for reducing these delays. The strategies adopted, implemented between April and September 1996, involved (i) keeping the ECG machine in the emergency department at all times, (ii) installing a facsimile machine, (iii) keeping Alteplase (rt-PA) in the emergency department, (iv) staff education, (v) allowing senior medical staff to initiate treatment if the consultant was not readily contactable. Resulting from these initiatives time delays (after first ECG) were reduced from a median time of 55 min in 1995 to a median time delay of 43 min in 1997. This study highlights areas of unnecessary delay in patients receiving thrombolytic therapy and shows that these delays can be reduced by the implementation of relatively simple strategies by medical and nursing staff. Time delays from the development of symptoms (usually chest pain) to arrival at triage were recorded when such a time was specified in the clinical notes. The median delay from the development of chest pain to triage was 73 min.

Aged↗
PubMed1987

Medicalization and its discontents.

This paper raises the question of the ethically proper balance in health care policy between the medical-clinical-high technology model of health service and the grass-roots, community based or traditional models of care. Paradoxical imbalances between the two approaches are traced to political, economic or prestige factors. Case studies examined include the hospitalization of non-contagious leprosy patients while protecting the anonymity of AIDS-infected prostitutes, medical resistance to the adoption of a clinical role by Community Cancer Centers, and the continued preference in some quarters for elaborate (and often delayed) hospital treatment for such problems as infant diarrhea, despite the availability of much simpler solutions, as in the case of the widely successful oral rehydration therapy. A balanced approach to world health problems, we argue, rests not on inflationary lowering of health care standards to achieve nominal victories, nor on stainless steel high technology panaceas but on mobilizing resources around human needs.

Acquired Immunodeficiency Syndrome↗
PubMed1996

The HERITAGE Family Study: quality assurance and quality control.

The HERITAGE (HEalth, RIsk factors, exercise Training And GEnetics) Family Study is the first multicenter family clinical trial of its kind. Conducted by a consortium of five universities in the United States and Canada, the study has as its primary goal to document the role of the genotype in the cardiovascular, metabolic, and hormonal responses to aerobic exercise training. A comprehensive protocol was implemented at four Clinical Centers (CC) for the generation of data on sedentary subjects. This group included 450 caucasians from 90 nuclear families (father, mother, three children) and 200 black subjects from 40 to 100 family units over a 5-year period. The entire family was tested before and after a 20-week exercise training program. The fifth participating center, the Data Coordinating Center (DCC), is responsible for data management and data analysis. A Consortium Coordinating Center (CCC) responsible for the overall coordination and direction of the study was established at the Quebec CC. Quality assurance and quality control are jointly coordinated by the CCC and the DCC. A multicenter study of this magnitude requires careful standardization of all procedures and constant monitoring of quality control at all levels of operation. This report describes the quality assurance and quality control measures implemented in the HERITAGE Family Study, including some examples with real data.

Adolescent↗
PubMed2004

Survey of oral care practices in US intensive care units.

BACKGROUND: Research has shown that oral care involving toothbrushes and topical antimicrobials improves the oral health of medically compromised patients and may reduce the incidence of nosocomial infections including pneumonia. This survey research was undertaken to determine the type and frequency of oral care in intensive care units (ICUs) in the United States and the attitudes, beliefs, and knowledge of health care workers. METHODS: A randomly selected survey of 102 ICUs within the continental United States participated with 556 respondents; 97% of respondents were registered nurses. MEASUREMENTS: Frequency and type of oral care provided, attitudes and beliefs, and knowledge and training in oral care were measured. RESULTS: Ninety-two percent of respondents perceived oral care to be a high priority. The primary methods of oral care involved the use of foam swabs, moisturizers, and mouthwash. Toothbrushes and toothpaste were used infrequently by almost 80% of respondents. The majority of nurses indicated a need for research-proven oral care standards and desired to learn more. CONCLUSIONS: In this random sample of ICUs, oral care methods were not consistent with current research and oral care protocols. The translation of oral care research into practice in the ICU may improve the quality of care and decrease the incidence of ventilator-associated pneumonia.

Critical Care↗
PubMed1997

Computerized decision support based on a clinical practice guideline improves compliance with care standards.

PURPOSE: Clinical guidelines are designed to assist in the management of specific diseases; however, these guidelines are often neglected in the delivery of care. The purpose of this study was to determine whether clinician use of an clinical practice guideline would increase in response to having, at the patient visit, a decision support system based on a practice guideline that generates a customized management protocol for the individual patient using data from the patient's electronic medical record. SUBJECTS AND METHODS: In a 6-month controlled trial at a primary care clinic, 58 primary care clinicians were randomized to receive either a special encounter form with the computer-generated guideline recommendations or a standard encounter form. The effect of computer-generated advice on clinician behavior was measured as rate of compliance with guideline recommendations. Data from 30 clinicians were analyzed; data from 28 clinicians were excluded because these clinicians did not meet predefined criteria for minimum exposure to diabetic patient care. RESULTS: Availability of patient management recommendations generated by the decision support system resulted in a two-fold increase in clinician compliance with care guidelines for diabetes mellitus (P = 0.01). Median compliance for the group receiving the recommendations was 32.0% versus 15.6% for the control group. CONCLUSION: Decision support based on a clinical practice guideline is an effective tool for assisting clinicians in the management of diabetic patients. This decision support system provides a model for how a clinical practice guideline can be integrated into the care process by computer to assist clinicians in managing a specific disease through helping them comply with care standards. Use of decision support systems based on clinical practice guidelines could ultimately improve the quality of medical care.

Decision Making, Computer-Assisted↗
PubMed1998

Dermatologists meet the primary care standard for first contact management of skin disease.

BACKGROUND: It has been suggested that first contact for skin disease should be the domain of primary care providers because they provide comprehensive services beyond those offered by dermatologists. OBJECTIVE: The purpose of this study was to test the hypothesis that dermatologists do not meet the standards for providing primary care to which generalists are held. METHODS: National Ambulatory Medical Care Survey data from the year 1995 were used to determine the frequency at which counseling and preventive examinations were performed at visits to primary care providers and dermatologists. RESULTS: Counseling and preventive examinations were performed at a minority of visits for skin disease. No counseling was reported at 91% of the visits to primary care providers and at 94% of visits to dermatologists. Preventive examinations other than blood pressure were done at 4.7% of the visits to primary care providers and at 1.5% of visits to dermatologists. CONCLUSION: The standard of primary care for skin disease, as set by the generalist, is attention to the skin disease and not comprehensive medical care. Dermatologists are best able to meet this standard.

Adolescent↗
PubMed2003

Nursing home closures: effects on capacity and reasons for closure.

OBJECTIVES: to identify the rate of closure of nursing homes for older people, the types of homes closing and the reasons for closure. DESIGN: mixed method study including a census and telephone survey of registration and inspection units and interviews with independent providers. PARTICIPANTS: 81 of 96 health authority and joint registration and inspection unit managers in England completed the census and 39 managers participated in a further telephone survey. Twenty-five independent providers were interviewed. RESULTS: closures resulted in a net loss of 6% of nursing homes and 4.9% of nursing places during 2000-2001. Smaller homes were more likely to close and were increasingly seen as unviable. The majority of closed homes were reported to have provided good quality care. Shortages of nursing staff were of widespread concern. The dominant combination of factors identified by providers was low fees and concerns about the cost implications of the new care standards. Changes in demand were reflected in the placement of high dependency residents in residential rather than nursing homes. CONCLUSIONS: in the absence of policy interventions capacity will continue to reduce, with smaller homes most likely to disappear. There is an urgent need to address the supply and efficient use of nursing staff skills in care homes. While fee levels are the primary concern the effect of the proposed care standards was clearly having an effect. Even with subsequent amendment to these standards, unless authorities use capacity funding to raise fees and improve expectations, providers are likely to continue to exit the market.

Aged↗
PubMed2004

The effectiveness of implementing a care pathway for femoral neck fracture in older people: a prospective controlled before and after study.

OBJECTIVES: To investigate whether a care pathway for older hip fracture patients can reduce length of stay while maintaining the quality of clinical care. DESIGN: Prospective study of patients admitted 12 months before and after implementation of a care pathway for the management of femoral neck fracture. Audit data for corresponding time periods from nearby orthopaedic units was used to control for secular trends. SETTING: Teaching hospital. SUBJECTS: Patients aged 65 years and over with a femoral neck fracture. EXCLUSION CRITERIA: multiple fractures, fractures due to malignancy, re-fracture, total hip replacement, previously entered into the study, operation performed elsewhere. Three-hundred and ninety-five (99%) and 369 (97%) case records were available for full analysis. MAIN OUTCOME MEASURES: primary outcome: length of stay on the orthopaedic unit. SECONDARY OUTCOMES: ambulation at discharge, discharge destination, in-hospital complications, 30 day mortality, readmission within 30 days of discharge, post-operative days the patient first sat out of bed and walked. RESULTS: Mean length of stay increased by 6.5 days (95% confidence interval 3.5-9.5 days, P < 0.0005) in the second period with a significant improvement in ambulation on discharge (odds ratio 1.6, 95% confidence interval 1.0-2.6, P = 0.033) and a trend towards reduction in admission to long term care (odds ratio 0.6, 95% confidence interval 0.3-1.0, P = 0.058). CONCLUSIONS: This care pathway was associated with longer hospital stay and improved clinical outcomes. Care pathways for hip fracture patients can be a useful tool for raising care standards but may require additional resources.

Aged↗
PubMedDate not supplied

Improving the quality of diabetes care in primary care practice.

The quality of care delivered to patients with diabetes has an impact on long-term outcomes. The purpose of this quality improvement project was to examine the effect of a Diabetes Disease Management Program (DDMP) on compliance with recommended process measures of care in primary care practice settings. Certified diabetes nurse educators visited five participating primary care practices biweekly for 1 year providing education to physicians and office staff on standards for diabetes management and to patients regarding self-management. Among 208 participants, 85.5% had >2 HbA1cs, 93.6% had lipid profiles, and 100% had foot examinations. Improvements in HbA1c (9.0% to 7.7%) were observed. Implementation of DDMP effectively promotes compliance with care standards in primary care practices.

Adult↗