Ambulatory Care Information Research Articles

Do we all speak the same language? A critical systemic functional discourse analysis of psychiatric hospital brochures

Background Over the last decades, treatment of patients with mental health diseases has shifted from longer-term in-hospital diagnosis and treatment to brief crisis diagnostic and/or treatment stays in hospital wards combined with ambulatory care preventing relapse and promoting patient-centered recovery. To guarantee a shared understanding of the nature of the care provided, it is important that hospital brochures and ambulatory care information are aligned, both in the way in which they define and understand recovery and regarding how they approach the empowerment and activation of the patient. Aim and research questions The overall aim of the study was to shed light on whether (1) hospital brochures used in crisis intervention centres in Flanders reflect the tenets of recovery-oriented and empowering care, and (2) the encoded messages are reflective of patients and their needs. Methods A systemic functional critical discourse analytic framework was used to analyze a small corpus of hospital brochures. Results Our findings suggest that the answers to both research questions are negative. Conclusion This small-scale qualitative study on the under-researched population of psychiatric patients admitted to crisis intervention wards highlights the complexities involved in imparting well-aligned psychiatric care messages to the patients, their home caregivers, the medical community and the general public.

Assessment of the production of cervical cancer care procedures in the Brazilian National Health System in 2015.

to assess the procedures production of screening, diagnostic investigation and precursor lesions treatment for cervical cancer in the Brazilian National Health System (SUS). normative evaluation with calculation of estimates of need based on national screening guidelines in two scenarios: organized (1) and opportunistic (2) screening; data were obtained from the SUS Ambulatory Care Information System and the Cervical Cancer Information System. considering the scenario 1, the production of cytopathologic exams (-46,9%) and biopsies (-44.9%) was below the necessary in Brazil, whereas colposcopy (61.3%) and precursor lesions treatments (37.4%) were above; in scenario 2, biopsies were below the necessary (-48.5%) whilst colposcopy (193.9%) and precursor lesions treatments (28.4%) were above. there were deficits in cytopathologic exams and biopsies and excess of colposcopies and treatment of precursor lesions in Brazil.

PCN49 - Real World Data on Multiple Myeloma Treatment Patterns: First and Second-Line Treatment in the Brazilian Public Health System

Multiple Myeloma (MM) is a bone marrow-based plasma cell neoplasm; data regarding current treatment patterns in Brazil are scarce. Brazilian Public Healthcare System (SUS) defines two procedures for first (1L) and second-line (2L) treatment for MM and reimburses it through High Complexity Procedures Authorization (APAC) System. The objective of this analysis was to analyze 1L and 2L treatment patterns in MM reimbursed during 2012-2016 by SUS and compare them to current Brazilian treatment guideline (PCDT). All APACs for procedures 03.04.03.018-0 (1L) and 03.04.03.019-8 (2L) during 2012-2016 considering the International Classification of Disease Code (ICD-10) C90.0 were extracted from the ambulatory care information system (SIA/SUS) from the Brazilian Health Information System. A key for decoding all chemotherapy inputs was developed by two health professionals and validated by one oncologist and fuzzy matching method was applied. Patient characteristics and treatments were assessed using summary statistics. Overall, 118,177 (1L) and 58,044 (2L) APACs were obtained, corresponding to 11,594 (1L) and 5,569 (2L) patients. Mean number of APACs per patient were 10.43±8.99 (1L) and 10.19±8.93 (2L). After Jan-2012, 8,947 patients in 1L and 3,486 in 2L were diagnosed with MM. Median time from first to last APAC was 7 months for 1L (IQR:2-13) and 6 months for 2L (IQR:2-13). Among patients in 1L, 48.6% were men; overall median age was 64 years (IQR:57-72). Drugs from 90.1% (1L) and 87.5% (2L) APACs could be decoded. Most used drug combinations reported for 1L-treatment were cyclophosphamide monotherapy (8.6%), cyclophosphamide+dexamethasone+thalidomide (7.7%) and melphalane+prednisone (4.9%); for 2L-treatment, cyclophosphamide monotherapy (9.7%), bortezomibe (6.3%) cyclophosphamide+dexamethasone+thalidomide (5.2%) were the most frequent. The most reported drug was a monotherapy not included in the PCDT recommendations, all other frequent combinations were coherent with the current PCDT. The results found are limited by the uncertainty in data input in the database.

The role of ambulatory care information systems in supporting the provision of holistic care for persons infected with the human immunodeficiency virus.

Given an appropriate conceptual model, such as the Wilson and Cleary model for linking clinical variables with health-related quality of life, ambulatory care information systems have the potential to facilitate holistic care for persons infected with the human immunodeficiency virus. Four examples of the manner in which an ambulatory care system can support the provision of holistic care are the contextualization of care through inclusion of the patient's voice, improved coordination of care and knowledge-harvesting through systems integration, timely application of agency-specific information and domain information and knowledge to an individual patient, and blurring of the boundaries of ambulatory care.

Measuring opportunities to expand ambulatory surgery in Canada

Enhancement of comparative ambulatory care information reporting systems will expand the ability of health care managers to assess accurately the opportunities and relative benefits and costs of substituting ambulatory care for traditional inpatient services without jeopardizing the five basic principles of Canada's health care system: universality, accessibility, portability, comprehensiveness, and public administration. In the long run, this will improve Canada's ability to provide high-quality and cost-effective health care within the constrained resources now available.

Evaluation methodology for ambulatory care information systems.

The central purpose of an ambulatory care information system is to communicate information to the practitioner to facilitate clinical decision making. The clinical decision can be considered the dependent output variable in a process in which the information system, the patient, clinician characteristics and the environment are the independent input variables. Evaluation methodologies must consider there relationships. Approaches using patients outcomes are problematic because of indirect relationship between the information system and patient outcomes, which limits both sensitivity and validity. A process measure technique that focuses on the clinical decision directly as the measure of output could be appropriate if the represented a generic sampling of clinical decisions made in ambulatory care. A new method under development based on an information theory concept may be more widely applicable than currently available methods.