A qualitative study exploring the benefits and challenges of implementing client centered care in a substance dependence rehabilitation service

2020 ◽  
Author(s):  
Esther Louise Davis ◽  
Peter J. Kelly ◽  
Frank P. Deane ◽  
Mark Buckingham ◽  
Danielle Breeze ◽  
...  
Keyword(s):  
Health Care ◽  
Substance Dependence ◽  
Rehabilitation Service ◽  
Future Research ◽  
Individual Interviews ◽  
Advantages And Disadvantages ◽  
Individualized Care ◽  
Centered Care ◽  
Substance Dependence Treatment ◽  
Treatment Settings

Abstract Background Client centered care is strongly advocated as key to improving the quality of health care. However, there is a notable absence of research about the acceptability and feasibility of a client centered approach in substance dependence treatment settings. The aim of this study was to explore client and staff perspectives of a new client centered model of care implemented at Kedesh Rehabilitation Services, a residential substance dependence treatment service.Methods Participants were client and staff at Kedesh between April 2018 and April 2019. Clients were invited to take part in a focus group and staff in individual interviews. Questions elicited client and staff experience of client centered care at Kedesh, including advantages and disadvantages. Staff were also asked to describe how they would define the client centered model. Thematic analysis was conducted on transcriptions of audio recordings.Results Four focus groups were conducted amongst 18 clients and 8 individual interviews amongst staff. Staff identified the defining features of client centered care as that which is flexible, comprehensive, open-minded and inclusive. Clients and staff shared predominantly positive views on the client centered model, with an emphasis on the satisfaction in providing and receiving what felt like more authentic and comprehensive care. Shared themes emerged for clients and staff on the challenge of striking a balance between flexibility and structure, and managing comprehensive and individualized care within existing knowledge, skills and resources.Conclusions Client centered care encourages health care organisations and providers to strive for a more holistic and empowering standard of care. Results support the acceptability of client centered care in residential substance dependence treatment settings for both clients and staff. Future research is needed to develop knowledge in interpreting, implementing, and assessing client centered care in the treatment of substance dependence.

Impact of the Physical Environment of Residential Health, Care, and Support Facilities (RHCSF) on Staff and Residents

2016 ◽  
Vol 48 (10) ◽  
pp. 1203-1241 ◽  
Author(s):  
Anjali Joseph ◽  
Young-Seon Choi ◽  
Xiaobo Quan
Keyword(s):  
Health Care ◽  
Physical Environment ◽  
The Elderly ◽  
Organizational Outcomes ◽  
Future Research ◽  
Care For The Elderly ◽  
Care And Support ◽  
Outdoor Environments ◽  
Centered Care ◽  
The Impact

The physical environment of residential health, care, and support facilities (RHCSF) is a critical component in providing supportive and resident-centered care for the elderly. Although past reviews of the literature have focused on specific settings for the elderly or specific residential populations of the elderly, a systematic literature review that covers the range of settings and populations has been lacking. This article provides an overview and synthesis of the most recent empirical evidence addressing the impact of the physical environment on residents and staff of RHCSFs. The review also identifies gaps where future research is needed. This review found 66 studies examining the relationship between the built environment and outcomes in three broad domains of resident quality of life, resident safety, and staff and organizational outcomes. The studies address a range of topics including the impact on elderly residents of the facility scale and size, outdoor environments, and environmental quality.

scholarly journals A Quantitative and Qualitative Study on Patient and Physician Perceptions of Nephrology Telephone Consultation During COVID-19

2022 ◽  
Vol 9 ◽  
pp. 205435812110667
Author(s):  
Seung Heyck Lee ◽  
Sonya Ramondino ◽  
Kerri Gallo ◽  
Louise M. Moist
Keyword(s):  
Health Care ◽  
Health Care Access ◽  
Well Being ◽  
Perceived Usefulness ◽  
Survey Study ◽  
Future Research ◽  
Cross Sectional ◽  
Care Clinic ◽  
Telephone Consultation ◽  
Advantages And Disadvantages

Background: COVID-19 required rapid adoption of virtual modalities to provide care for patients with a chronic disease. Care was initially provided by telephone, which has not been evaluated for its effectiveness by patients and providers. This study reports patients’ and nephrologists’ perceptions and preferences surrounding telephone consultation in a chronic kidney disease (CKD) clinic. Objective: To evaluate patient and physician perspectives on the key advantages and disadvantages of telephone consultations in a nephrology out-patient clinic setting. Design: Cross-sectional observational survey study. Setting: General nephrology clinic and a multidisciplinary kidney care clinic in London, Ontario, Canada. Participants: Patients with CKD who were fluent in English and participated in at least one telephone consultation with a nephrologist during the COVID-19 pandemic. Methods and measurements: Nephrologists’ and participants’ input facilitated the development of both patient and nephrologist surveys. Participants provided self-reported measures in 5 domains of satisfaction: user experience, technical quality, perceived effectiveness on well-being, perceived usefulness, and effect on interaction. Nephrologists provided self-reported measures within 6 categories: general experience, time management, medication changes, quality of care, job satisfaction, and challenges/strengths. Descriptive statistics were used to present data. Content analysis was performed on 2 open-ended responses. Results: Of the 372 participants recruited, 235 participated in the survey (63% response). In all, 79% of the participants were ≥65 years old and 91% were white. Telephone consultation was a comfortable experience for 68%, and 73% felt it to be a safer alternative during the pandemic. Although 65% perceived no changes to health care access, most reported spending less time and fewer resources on transit and parking. Disadvantages to telephone consultation included a lack of physical examination and reduced patient-physician rapport. Eleven of 14 nephrologists were surveyed, with most reporting confidence in the use of telephone consultation. Physician barriers to telephone consultation included challenges with communications and lack of technology to support telephone clinics. Limitations: Our survey included a majority of older, white participants, which may not be generalizable to other participants particularly those of other ages and ethnicity. Conclusion: Although both patients and nephrologists adapted to telephone consultations, there remain opportunities to further explore populations and situations that would be better facilitated with an in-person visit. Future research in virtual care will require measurement of health care outcomes and economics. Trial registration: Not applicable as this was a survey.

scholarly journals 2061

2017 ◽  
Vol 1 (S1) ◽  
pp. 68-68
Author(s):  
Michelle Patch ◽  
Jacquelyn Campbell
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Health Care System ◽  
Qualitative Data ◽  
Future Research ◽  
Adult Women ◽  
Care Seeking ◽  
Individual Interviews ◽  
Ed Visits ◽  
Care System

OBJECTIVES/SPECIFIC AIMS: Aim 1—estimate prevalence and associated characteristics of nonfatal, non-self-inflicted strangulation among women ages 18 and older who presented to a US emergency department between 2006 and 2013. Aim 2—explore care-seeking behaviors, the context of the care seeking, treatment expectations and perceived diagnosis in a sample of women ages 18 and older who present to a US emergency department and report being strangled by an intimate partner. Aim 3—merge and synthesize findings from both the quantitative and qualitative strands to provide a more complete understanding of post-strangulation emergency care of women. METHODS/STUDY POPULATION: This mixed-methods study will use a convergent parallel design, with a single phase of concurrent and independent data collection. Analysis of quantitative and qualitative data will be performed separately then compared, with main findings integrated during the interpretation phase and presented in a merged data analysis display. IRB review and approval will be obtained before initiating this study. Aim 1 will include a cross-sectional analysis of 2006–2013 Nationwide Emergency Department Sample (NEDS) data, from the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project (HCUP). NEDS is the US’s largest all-payer emergency department (ED) database, providing national estimates of hospital-based ED visits from ~120 to 135 million ED visits/year (weighted). For this study, we will examine data from patients meeting inclusion criteria with an International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM; Medicode, 1996) code of strangulation. For this strand, females aged 18 years or older who presented to a US emergency department between 2006 and 2013 will be included. The outcome variable will be non-fatal, non-self-inflicted strangulation, defined using at least one of the ICD-9-CM codes for strangulation. These codes are: 994.7 (“asphyxiation and strangulation”), E963 (“assault by hanging and strangulation”), E983.8 (“strangulation or suffocation by other specified means undetermined whether accidentally or purposely inflicted”), and E983.9 (“strangulation or suffocation by unspecified means undetermined whether accidentally or purposely inflicted”). Patients with a concurrent ICD-9-CM code for suicide attempt (E953, “Suicide and self-inflicted injury by hanging, strangulation and suffocation”) will be excluded, to minimize self-inflicted assault events. Aim 2 will employ a narrative descriptive approach, with semistructured individual interviews to gather more information about women’s experiences when engaging the health care system after being strangled. Medical records related to the strangulation event will also be reviewed for diagnostic codes and other nursing and/or medical notes that may relate to diagnoses, treatment and referrals. For this strand, women aged 18 years or older who present for care to an urban, academic ED will be recruited, purposely sampling those reporting strangulation as a reason for their visit. We anticipate interviewing ~20–30 women to achieve saturation of information. RESULTS/ANTICIPATED RESULTS: Data from the NEDS from 2006 to 2013 will be analyzed for prevalence and associated characteristics of women seeking care after being strangled. Individual interviews and medical record reviews of a small sample of adult women will be conducted to explore women’s in-depth experiences within the health care system. Results from both the quantitative and qualitative analyses will then be collectively compared and interpreted to better synthesize the evidence from this work. Convergent and divergent findings will be presented in a merged data analysis display (Creswell and Plano Clark, 2011). Qualitative data will be used to fill the knowledge gap remaining from the quantitative analysis, and to explain and contextualize some of the findings. Such integration will help expand the current limited evidence on care of strangled women, and will identify additional research questions that will guide future research in this area. DISCUSSION/SIGNIFICANCE OF IMPACT: To our knowledge, this study will be the first to explore this issue using a nationally representative sample of adult women who sought emergency medical care for strangulation analyzed in conjunction with a detailed qualitative analysis of strangled women’s experiences with the health care system. The resulting knowledge will be critical to informing clinical assessment, intervention and prevention efforts for this vulnerable population, as well as public policy and future research regarding this specific violence tactic.

A Review of Drug Side Effect Identification Methods

2020 ◽  
Vol 26 (26) ◽  
pp. 3096-3104 ◽  
Author(s):  
Shuai Deng ◽  
Yige Sun ◽  
Tianyi Zhao ◽  
Yang Hu ◽  
Tianyi Zang
Keyword(s):  
Side Effects ◽  
Future Research ◽  
Drug Side Effects ◽  
Important Indicator ◽  
Advantages And Disadvantages ◽  
Key Points ◽  
Network Methods ◽  
Future Research Directions ◽  
The One ◽  
Approved Drugs

Drug side effects have become an important indicator for evaluating the safety of drugs. There are two main factors in the frequent occurrence of drug safety problems; on the one hand, the clinical understanding of drug side effects is insufficient, leading to frequent adverse drug reactions, while on the other hand, due to the long-term period and complexity of clinical trials, side effects of approved drugs on the market cannot be reported in a timely manner. Therefore, many researchers have focused on developing methods to identify drug side effects. In this review, we summarize the methods of identifying drug side effects and common databases in this field. We classified methods of identifying side effects into four categories: biological experimental, machine learning, text mining and network methods. We point out the key points of each kind of method. In addition, we also explain the advantages and disadvantages of each method. Finally, we propose future research directions.

Unfunded Public Employee Health Care Benefits and GASB No. 45

2007 ◽  
Vol 21 (3) ◽  
pp. 245-263 ◽  
Author(s):  
Elizabeth K. Keating ◽  
Eric S. Berman
Keyword(s):  
Health Care ◽  
Financial Reporting ◽  
Full Range ◽  
Financial Reports ◽  
Employment Benefits ◽  
Care Plans ◽  
Advantages And Disadvantages ◽  
Government Accounting ◽  
The Government ◽  
The Impact

The Government Accounting Standards Board (GASB) recently released Statement No. 45, Accounting and Financial Reporting by Employers for Post-Employment Benefits Other Than Pensions and its companion Statement No. 43 for pooled stand-alone health care plans, which will profoundly affect American governmental finance. The goal of this article is to encourage governments to consider carefully a full range of options in funding and restructuring other post-employment benefits (OPEB). This article will review Statement No. 45's potential impact on governments and review existing disclosures in financial reports as well as bond offering statements. The article will discuss the statement's impact on budgets and governmental operations, including collective bargaining. Funding options under Statement No. 45 will be detailed, including the advantages and disadvantages of irrevocable trusts and OPEB bonds. The article will also discuss the impact of Medicare Part D subsidies received by governments, as well as the bond rating implications of policy decisions surrounding OPEB. As the largest government entities are just now implementing GASB Statement No. 45, estimates of the magnitude of unfunded OPEB liabilities are limited as are the strategies likely to be adopted to cover these obligations. This article offers a summary of the unfunded OPEB liabilities reported by states and major cities and suggests some measures for assessing the ability of these entities to address these costs.

scholarly journals A Review of Dynamic Balancing for Robotic Mechanisms

Robotica ◽  
2020 ◽  
Vol 39 (1) ◽  
pp. 55-71 ◽  
Author(s):  
Bin Wei ◽  
Dan Zhang
Keyword(s):  
Future Research ◽  
Dynamic Balancing ◽  
Advantages And Disadvantages

SUMMARYThe authors summarize the main dynamic balancing methods of robotic mechanisms in this paper. The majority of dynamic balancing methods have been presented, and there may be other dynamic balancing methods that are not included in this paper. Each of the balancing methods is reviewed and discussed. The advantages and disadvantages of each method are presented and compared. The goal of this paper is to provide an overview of recent research in balancing. The authors hope that this study can provide an informative reference for future research in the direction of dynamic balancing of robotic mechanisms.

scholarly journals Validity of the Gender Dysphoria diagnosis and incidence trends in Sweden: a nationwide register study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Malin Indremo ◽  
Richard White ◽  
Thomas Frisell ◽  
Sven Cnattingius ◽  
Alkistis Skalkidou ◽  
...  
Keyword(s):  
Gender Dysphoria ◽  
Age Groups ◽  
Medical Intervention ◽  
Future Research ◽  
Advantages And Disadvantages ◽  
Incidence Trends ◽  
Interaction Terms ◽  
Definition Of ◽  
The Individual ◽  
Nationwide Register Study

AbstractThe aim of this study was to examine the validity of the Gender Dysphoria (GD) diagnoses in the Swedish National Patient Register (NPR), to discuss different register-based definitions of GD and to investigate incidence trends. We collected data on all individuals with registered GD diagnoses between 2001 and 2016 as well as data on the coverage in the NPR. We regarded gender confirming medical intervention (GCMI) as one proxy for a clinically valid diagnosis and calculated the positive predictive value (PPV) for receiving GCMI for increasing number of registered GD diagnoses. We assessed crude and coverage-adjusted time trends of GD during 2004–2015 with a Poisson regression, using assigned sex and age as interaction terms. The PPV for receiving GCMI was 68% for ≥ 1 and 79% for ≥ 4 GD-diagnoses. The incidence of GD was on average 35% higher with the definition of ≥ 1 compared to the definition of ≥ 4 diagnoses. The incidence of GD, defined as ≥ 4 diagnoses increased significantly during the study period and mostly in the age categories 10–17 and 18–30 years, even after adjusting for register coverage. We concluded that the validity of a single ICD code denoting clinical GD in the Swedish NPR can be questioned. For future research, we propose to carefully weight the advantages and disadvantages of different register-based definitions according to the individual study’s needs, the time periods involved and the age-groups under study.

scholarly journals Learning from and Leveraging Multi-Level Changes in Responses to the COVID 19 Pandemic to Facilitate Breast Cancer Prevention Efforts

2021 ◽  
Vol 18 (13) ◽  
pp. 6999
Author(s):  
Deborah J. Bowen ◽  
Kelly E. Rentscher ◽  
Amy Wu ◽  
Gwen Darien ◽  
Helen Ghirmai Haile ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Cancer Prevention ◽  
Care Delivery ◽  
Breast Cancer Prevention ◽  
Health Care Use ◽  
Economic Life ◽  
Future Research ◽  
Multi Level ◽  
And Shifts

The coronavirus pandemic (COVID-19) has had multilevel effects on non-COVID-19 health and health care, including deferral of routine cancer prevention and screening and delays in surgical and other procedures. Health and health care use has also been affected by pandemic-related loss of employer-based health insurance, food and housing disruptions, and heightened stress, sleep disruptions and social isolation. These disruptions are projected to contribute to excess non-COVID-19 deaths over the coming decades. At the same time municipalities, health systems and individuals are making changes in response to the pandemic, including modifications in the environmental to promote health, implementation of telehealth platforms, and shifts towards greater self-care and using remote platforms to maintain social connections. We used a multi-level biopsychosocial model to examine the available literature on the relationship between COVID-19-related changes and breast cancer prevention to identify current gaps in knowledge and identify potential opportunities for future research. We found that COVID-19 has impacted several aspects of social and economic life, through a variety of mechanisms, including unemployment, changes in health care delivery, changes in eating and activity, and changes in mental health. Some of these changes should be reduced, while others should be explored and enhanced.

A Scoping Review of Telehealth-Assisted Case Management for Chronic Illnesses

2021 ◽  
pp. 019394592110089
Author(s):  
Jee Young Joo ◽  
Megan F. Liu
Keyword(s):  
Health Care ◽  
Case Management ◽  
Scoping Review ◽  
Access To Health Care ◽  
Health Care Services ◽  
Care Delivery ◽  
Management Practice ◽  
Empirical Studies ◽  
Chronic Illnesses ◽  
Future Research

This scoping review aimed to examine telehealth-assisted case management for chronic illnesses and assess its overall impact on health care delivery. Guided by the PRISMA statement, this review included 36 empirical studies published between 2011 and 2020. This study identified three weaknesses and four strengths of telehealth-assisted case management. While the weaknesses were negative feelings about telehealth, challenges faced by patients in learning and using telehealth devices, and increased workload for case managers, the strengths included efficient and timely care, increased access to health care services, support for patients’ satisfaction, and cost savings. Future research can be designed and conducted for overcoming the weaknesses of telehealth-assisted case management. Additionally, the strengths identified by this review need to be translated from research into case management practice for chronic illness care. This review not only describes the value of such care strategy, but also provides implications for future nursing practice and research.

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