Care Case Management Research Articles

Empathetic Leadership to Coach and Support Interprofessional Teams.

Vivian Campagna, DNP, RN-BC, CCM, ICE-CCP, is the Chief Industry Relations Officer of the Commission for Case Manager Certification (CCMC), the first and largest nationally accredited organization that certifies more than 50,000 professional case managers and disability management specialists with its CCM and CDMS credentials. With more than 30 years of case management experience, Vivian spent much of her professional career in acute care case management, before joining the Commission. Ellen Mitchell, MA, RN, CCM, is the Director for Industry Relations for CCMC. Ellen has more than 25 years of experience in the field of hospital case management and has presented nationally on topics of interest to the specialty. Ellen holds a master's degree in Acute Care Nursing. Address correspondence to Vivian Campagna, DNP, RN-BC, CCM, Commission for Case Manager Certification, 1120 Route 73, Ste 200, Mount Laurel, NJ 08054 ([email protected]). The authors report no conflicts of interest.

More than just Reminders: Using text Messaging to Improve HIV care Outcomes Among Youth and Young Adults Living with HIV.

This study evaluated engagement, satisfaction, and efficacy of an automated and live two-way text messaging intervention that linked youth and young adults at high risk for poor HIV outcomes to their medical case managers, with the aims of increasing viral load suppression rates and improving medical visit attendance. Participants (N = 100) were an average age of 22-23 years old. Most were Black (93%) and men who have sex with men (82%). A total of 89,681 automated text messages were sent to participants; and 62% of participants engaged in monthly text-message exchanges with medical case managers. McNemar's test results indicated that a significantly greater proportion of intervention participants were virally suppressed at 6 and 12month follow-up than at enrollment. Adjusted odds ratio results showed a significant association between likelihood of achieving viral suppression at 6 and 12 months, and a greater number of participant responses to automated text messages. Future research should prospectively compare outcomes between usual care case management and usual care plus text-messaging to test for significant differences between groups.

Developing a model for rehabilitation in the home as hospital substitution for patients requiring reconditioning: a Delphi survey in Australia

BackgroundReconditioning for patients who have experienced functional decline following medical illness, surgery or treatment for cancer accounts for approximately 26% of all reported inpatient rehabilitation episodes in Australia. Rehabilitation in the home (RITH) has the potential to offer a cost-effective, high-quality alternative for appropriate patients, helping to reduce pressure on the acute care sector. This study sought to gain consensus on a model for RITH as hospital substitution for patients requiring reconditioning.MethodsA multidisciplinary group of health professionals working in the rehabilitation field was identified from across Australia and invited to participate in a three-round online Delphi survey. Survey items followed the patient journey, and also included items on practitioner roles, clinical governance, and budgetary considerations. Survey items mostly comprised statements seeking agreement on 5-point Likert scales (strongly agree to strongly disagree). Free text boxes allowed participants to qualify item answers or make comments. Analysis of quantitative data used descriptive statistics; qualitative data informed question content in subsequent survey rounds or were used in understanding item responses.ResultsOne-hundred and ninety-eight health professionals received an invitation to participate. Of these, 131/198 (66%) completed round 1, 101/131 (77%) completed round 2, and 78/101 (77%) completed round 3. Consensus (defined as ≥ 70% agreement or disagreement) was achieved on over 130 statements. These related to the RITH patient journey (including patient assessment and development of the care plan, case management and program provision, and patient and program outcomes); clinical governance and budgetary considerations; and included items for initial patient screening, patient eligibility and case manager roles. A consensus-based model for RITH was developed, comprising five key steps and the actions within each.ConclusionsStrong support amongst survey participants was found for RITH as hospital substitution to be widely available for appropriate patients needing reconditioning. Supportive legislative and payment systems, mechanisms that allow for the integration of primary care, and appropriate clinical governance frameworks for RITH are required, if broad implementation is to be achieved. Studies comparing clinical outcomes and cost–benefit of RITH to inpatient rehabilitation for patients requiring reconditioning are also needed.

Abstract B117: Disparities in non-surgical admissions for survivors of cervical cancer: Understanding morbidity and survivorship needs through hospital admissions

Abstract Purpose: To utilize data on hospital admissions among patients with cervical cancer during treatment and long-term surveillance to better understand disease and treatment related burdens, explore inpatient utilization of services, and identify risk factors for admission. Methods: Retrospective chart review was performed on patients treated for cervical cancer from 2014 to 2020 at a single academic institution. Clinical, demographic and treatment information and hospital admission characteristics were collected. Discharge diagnoses were grouped and summarized with descriptive statistics. Univariate and multivariate regression were used to examine associations between patient characteristics and likelihood of admission. Results: Of 366 patients identified, 188 (51%) were admitted to the hospital for cancer or treatment-related reasons excluding planned admissions for initial treatment, in the median follow-up period of 3.6 years (IQR 1.4-6.4), with a median number of 2 admissions (IQR 1-4) and median length of stay 4 days (IQR 2-7). Of those admitted, 65 (35%) had discharge diagnoses belonging to more than one clinical category. The five most common discharge diagnoses were gastrointestinal problems (40%), genitourinary problems (35%), infection (35%), pain control (21%), and vaginal bleeding (19%). A significant proportion of admitted patients underwent inpatient interventions including imaging (68%), surgical procedures (57%), antibiotics (52%), transfusion of blood products (40%), and interventional radiology procedures (28%) and utilized supportive and specialty care including case management (53%), physical therapy (40%), occupational therapy (36%), social work (36%), nutrition (31%), and palliative care (23%). On univariate analysis, Black patients (OR 3.0, p<.001), uninsured patients (OR 5.2, p<.001), those with lower performance status (OR 1.7, p<.001), higher stage (OR 2.9, p<.001), patients who received radiation or chemoradiation (OR 3.9, p<.001), and those with recurrence (OR 5.1, p<.001) were more likely to be hospitalized after completion of treatment. On multivariate analysis, odds of admission were higher among Black patients (aOR 2.4, p<.01), uninsured patients (aOR 2.7, p<.05), those with lower performance status (aOR 2.7, p<.05), and those with recurrence (aOR 5.5, p<.001). Conclusion: Patients with cervical cancer represent a high-risk population frequently hospitalized after initial treatment, due to disease and treatment-related toxicities. Black patients, uninsured patients, those with recurrence, and those with lower performance status faced higher odds of admission, possibly reflecting higher survivorship burden. Comprehensive, team-based approaches to address complex symptom burden are needed for this high risk group. Patient-reported outcomes and needs assessments should also be considered to design programming to address complex needs in this patient population. Citation Format: Rayne Peerenboom, Sarah Ackroyd, Chuanhong Liao, Aarthi Koripelly, Nita Lee. Disparities in non-surgical admissions for survivors of cervical cancer: Understanding morbidity and survivorship needs through hospital admissions [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B117.

EXPERIENCES OF DISTRICT NURSES WITH MAKING DECISIONS ABOUT THE USAGE OF INVOLUNTARY TREATMENT

Abstract District nurses play a key role in care of older Persons Living with Dementia (PLWD) who still live in their own home environment. Studies show that they often have to deal with decision-making about and the usage of involuntary treatment. Involuntary treatment is care provided that they resist to and/or have not given consent to, such physical restraints, psychotropic medication. This study aimed to describe district nurses’ experiences regarding the decision-making processes about and the usage of involuntary treatment among PLWD. A qualitative study design with a grounded theory approach was used. During semi-structured interviews, 16 district nurses shared experiences in 31 different cases of involuntary treatment use among PLWD. Results show that district nurses were often not involved in the decision-making process. In most cases, family caregivers decided solely to use involuntary treatment, and district nurses were asked to do also. District nurses experienced these situations as difficult to deal with. They felt that they were torn between providing “good care”, wishes of PLWD, and meeting the expectations of family caregivers. Their experiences were negatively affected if PLWD verbally rejected the care provided, they were unable to enter into a dialogue with the caregivers about the care provided, and if they did not have sufficient knowledge about how to deal with PLWD. These findings indicate the importance, of proactive case management in dementia care at home. District nurses can facilitate this by going into dialogue between PLWD and his caregivers, in order to provide person-centered dementia care at home.

EXPLORING FRONTLINE PERSONNELS’ PERCEPTIONS OF SUPPORT, KNOWLEDGE, AND RESOURCES FOR ELDER ABUSE

Abstract In Virginia, the number of both reported and substantiated cases of abuse in later life have grown steadily over the last several years (DARS, 2021; O’Connor, 2019). Unfortunately, the resources provided to combat elder abuse have not maintained the same steady increase; in many cases, funding to agencies that work to prevent abuse in later life has even been reduced (DARS, 2021). To better understand the gap that exists between need and available resources in Virginia, we conducted an exploratory sequential mixed methods study [QUAL → quan] (Creswell & Plano Clark, 2018). In the qualitative strand, we conducted a series of interviews and focus groups with professionals who often are called upon to respond/intervene when elder abuse is suspected: aging and victim services (n = 9), healthcare providers (n = 7), law enforcement (n = 8). Three themes emerged from the qualitative data: increasing capacity, prevention/coordination, and ageism. Findings from the qualitative strand were then used to guide implementation of the quantitative strand. These participants (N = 2,891) worked in a variety of frontline settings with older adults or in aging services, mostly in health care, law enforcement, social services. Project findings point to a need for increased resources for and training on elder abuse, a shift from reaction to prevention of abuse, improved care coordination and case management, and a need to reduce harmful ageist beliefs. Moreover, our findings highlight the effect structural and societal ageism at the policy level perpetuates the prevalence of abuse in later life.

Case management and psychosocial care services for child and adolescent survivors of rape and sexual abuse

A child's right to life is violated by sexual abuse, which also represents an abuse of power. The case management and psychological care services provided to the child and adolescent survivors of rape and sexual abuse were evaluated in this study. Three (3) Registered Social Workers and five (5) residents from the Home for Women and Children (HWC) in Amas, Kidapawan City, Philippines, took part in the study. Before the incidents, the residents were all high school students aged 14 to 19 years old. Based on the findings, the caseworkers were unable to provide adequate psychological support, and the staff and the caseworkers were also unable to adequately explain to the residents that they could always return for additional help. The clients were uncomfortable telling their stories, felt blamed by the staff and caregivers for the abuse, were bored in the center, and missed their families, and many were still unsatisfied with the care services offered by the HWC because the perpetrator had not been jailed yet, thus, their home is not yet safe for them. The head of the HWC recommends that the client's integration plan be developed, preferably with a six-month aftercare program or monitoring. Also, there must be suitable strategies to avoid and respond to sexual violence. Clients should receive more outstanding psychosocial care, and employees and caseworkers should receive other pieces of training, seminars, and workshops to improve the services provided in the HWC

Emotion-focused communication training online: Development and evaluation of acceptability

ABSTRACT Emotion-focused communication can improve the delivery of care for long-term care recipients, especially individuals’ living with dementia. The purpose of this manuscript is to describe the process of translating the Emotion-Focused Communication Training (EFCT) for long-term care staff from an in-person workshop to an online program and evaluate its acceptability and impact on knowledge of emotion-focused communication and perceived self-efficacy for utilizing emotion-focused communication. The online course was developed following the ADDIE (Analysis, Design, Development, Implementation, Evaluation) Model. The program teaches participants to better identify and manage their own emotions and others’ emotions in care. Pre- and post-training t-test comparisons on data collected from 247 caregivers across disciplines in long-term care (direct care workers, life-enrichment/activities staff, health care providers, case managers, health educators, students, administrators, ombudsmen, dietary, housekeeping, or maintenance staff, human resources employees, family care partners, and others) indicated a significant increase in level of knowledge of emotion-focused communication and confidence in applying the learned knowledge and skills in care (increased self-efficacy). Participants also reported high levels of program acceptability. Overall, findings indicate the benefits of translating an in-person training opportunity for caregivers into an interactive online experience; implications for caregivers and care recipients are discussed.

Foster Care Case Management and Child developmental Outcomes: Big Data Analysis for Case Management Records

연구목적: 본 연구의 목적은 가정위탁 사례관리의 현황과 그 성과를 파악하는 데 있다. 이를위하여 이전에 분석된 적이 없었던 가정위탁 사례관리기록의 내용을 분석하고 위탁아동, 위탁부모, 친부모에게 제공된 서비스의 양과 아동 발달성과 간의 관계를 파악하였다. 방법: 본 연구는 2019 가정위탁패널 1-2차년도 조사에 참여한 261명 아동에 대한 10개월 간의사례관리 기록(서비스제공일지)과 설문조사를 통해 측정된 그들의 발달성과를 분석하였다. 서비스제공일지 내용 분석을 위해서는 빅데이터 분석방법 중 키워드 빈도분석, 토픽모델링 분석등을 활용하였으며 서비스 제공 양과 아동 발달성과 간의 관계는 회귀분석을 통해 확인하였다. 결과: 서비스제공일지 분석 결과, 우선 위탁유형 별로 제공된 서비스 종류에 있어 큰 차이가없음을 알 수 있었다. 키워드분석 및 토픽모델링 분석 결과, 여성 양육자에 대한 키워드와 토픽이주되게 드러나 가정위탁의 주양육자는 여성이라고 인식된다는 점과 가정위탁 사례관리 기록이아동 중심보다는 양육자 중심으로 기술된다는 것을 파악할 수 있었다. 또한, 일반위탁의 경우친족위탁에서 나타나지 않던 ‘친가정서비스’, ‘자조모임’, ‘공적자원연계’ 등이 제공일지의 토픽으로 등장하였다. 각 서비스 종류의 양이 아동발달에 미친 영향을 보면, 전화상담이 많이 제공될수록 자아존중감, 우울·불안, 위축, 공격성에, 자립지원서비스는 위축에 각각 영향을 미치는것으로 나타났다. 결론: 본 연구 결과를 바탕으로 가정위탁 사례관리 개선 및 사례관리 기록 체계 개선방안에대하여 논하였다.Objectives: The purpose of this study was to explore the status of foster care case management and the relationship between case management and children's developmental outcomes. Methods: This study analyzed the contents of case management records of ten months of 261 foster care children who participated in the second wave survey of the 2019 foster care panel. In addition, the study merged data pertaining to the service provisions and survey results which measured children’s developmental outcomes. Results: As big data analysis, we used the keyword frequency analysis and topic modeling analysis methods. To analyze the relationship between service provision amounts and children's developmental outcomes, a partial correlation analysis was utilized. The results of the big data analysis were as follows. Firstly, there were no significant differences according to the types of foster care. Secondly, case management records showed that the main caregivers for children were women regardless of the type of foster care. Thirdly, the results of the topic modeling analysis revealed that ‘family home service’, ‘self-help groups’, and ‘links to public services’ were the main topics in terms of services provided only in non-kinship foster care groups. The results of the regression analysis showed that when more ‘telephone counseling’ and ‘services for independent living’ were provided, better outcomes in children's self-esteem, depression/anxiety, social withdrawal, and aggression could be expected. Conclusions: Based on these results, practice and policy implications were discussed to improve foster care case management.

Financing care for Severe Stigmatizing Skin Diseases (SSSDs) in Liberia: challenges and opportunities

IntroductionNeglected tropical diseases (NTDs) are an important global health challenge, however, little is known about how to effectively finance NTD related services. Integrated management in particular, is put forward as an efficient and effective treatment modality. This is a background study to a broader health economic evaluation, seeking to document the costs of integrated case management of NTDs versus standard care in Liberia. In the current study, we document barriers and facilitators to NTD care from a health financing perspective.MethodsWe carried out key informant interviews with 86 health professionals and 16 national health system policymakers. 46 participants were active in counties implementing integrated case management and 40 participants were active in counties implementing standard care. We also interviewed 16 patients and community members. All interviews were transcribed and analysed using the thematic framework approach.FindingsWe found that decentralization for NTD financing is not yet achieved – financing and reporting for NTDs is still centralized and largely donor-driven as a vertical programme; government involvement in NTD financing is still minimal, focused mainly on staffing, but non-governmental organisations (NGOs) or international agencies are supporting supply and procurement of medications. Donor support and involvement in NTDs are largely coordinated around the integrated case management. Quantification for goods and budget estimations are specific challenges, given the high donor dependence, particularly for NTD related costs and the government’s limited financial role at present. These challenges contribute to stockouts of medications and supplies at clinic level, while delays in payments of salaries from the government compromise staff attendance and retention. For patients, the main challenges are high transportation costs, with inflated charges due to fear and stigma amongst motorbike taxi riders, and out-of-pocket payments for medication during stockouts and food/toiletries (for in-patients).ConclusionOur findings contribute to the limited work on financing of SSSD services in West African settings and provide insight on challenges and opportunities for financing and large costs in accessing care by households, which is also being exacerbated by stigma.

Case Management or Child Care: Which Has the Greater Impact on Parental Human Capital and Self-Sufficiency in Two-Generation Programs?

Case Management or Child Care: Which Has the Greater Impact on Parental Human Capital and Self-Sufficiency in Two-Generation Programs?

Inequities in Telehealth Use Associated with Payer Type During the COVID-19 Pandemic.

Introduction: The COVID-19 pandemic has prompted a shift in health care delivery and compelled a heavier reliance on telehealth. The objective of this study was to determine if differences in coverage policies by payer type resulted in differential telehealth use during the first 3 months of the COVID-19 pandemic. In this population-based cohort study of low-income Arkansans, Medicaid beneficiaries enrolled in the traditional Primary Care Case Management (PCCM) program were compared with Medicaid beneficiaries covered through premium assistance in private Qualified Health Plans (QHPs). Methods: A retrospective review was conducted of insurance claims records from June 1, 2019, to June 30, 2020, for synchronous telehealth and mobile health (m-health) visits, as well as other forms of telehealth. To establish the baseline equivalence of enrollees in the two groups, propensity score matching design was used on demographic and geographic characteristics, Charlson Comorbidity Index, broadband availability, and prior service utilization. Results: Compared with enrollees in the PCCM program, Medicaid expansion enrollees in QHPs had higher odds of having had at least one telehealth visit (adjusted odds ratio [aOR] = 1.35, 95% confidence interval [CI]: 1.29-1.42) during the early phase of the COVID-19 pandemic. Categorizing utilizations by domain, QHP enrollees were more likely to use synchronous telehealth (aOR = 1.31; 95% CI: 1.25-1.37) and m-health (aOR = 5.91; 95% CI: 4.25-8.21). A higher proportion of QHP enrollees also had at least one mental or behavioral health telehealth session (aOR = 1.13; 95% CI: 1.07-1.19). Conclusions: Our study demonstrated that within low-income populations, payer type was associated with inequitable access to telehealth during the early phase of the COVID-19 pandemic.

28 Addressing Workplace Violence: Health Care Staff Safety, a Culture of Caring

28 Addressing Workplace Violence: Health Care Staff Safety, a Culture of Caring

Bilingual care navigation and enhanced case management during COVID-19.

COVID-19 disparities exposed health inequity across socioeconomic status, with community members of color experiencing higher rates of COVID-19 infections, hospitalizations, and death. Racial/ethnic differences were especially disparate in Benton and Washington counties in northwest Arkansas, a region in the United States that experienced high COVID-19 infection rates. To address these disparities and support families with COVID-19, the University of Arkansas for Medical Sciences and Community Clinic (a federally qualified health center) worked with the Arkansas Department of Health and community partners to develop systematic Care Navigation and Enhanced Case Management. During an initial screening process, contact tracers offered Care Navigation and Enhanced Case Management services to individuals who tested positive for COVID-19 within Washington and Benton counties. Bilingual community health navigators, social workers, and nurses began providing enhanced case management to households that accepted services. Between September 9, 2020 and June 19, 2021, 3,502 households representing ∼13,000 individuals were offered services, and 1,511 (43.1%) households requested/accepted services. Based on our experience, we provide four recommendations for practice: (a) provide contact tracing in community members' preferred language, (b) incorporate assessments into the contact tracing process to ensure community members have necessary resources for quarantine, (c) implement comprehensive care navigation and case management services for those who need additional support, and (d) integrate bilingual health navigators who are part of the target community into the process. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Nursing case management in the palliative care: Scoping review

Background & Aim: Palliative care is of vital importance for the quality of life of the person who benefits from it. Nursing case management provides useful tools for optimizing the care that is provided, thus being an important resource for improving them in an area as complex as palliative care. This study aimed to map scientific evidence on nursing case management in the context of palliative care.
 Methods & Materials: Scoping review was done according to the eligibility criteria suggested by Joanna Briggs Institute: population (adults who benefit from palliative care), concept (studies in which nursing case management is implemented), and context (studies in the palliative, hospital or home care). The research was conducted in CINAHL (via EBSCO), MEDLINE (via PUBMED), COCHRANE, Scielo, LILACS, and MedicLatina databases; grey literature was researched in RCAAP, DART-Europe, and OpenGrey. Previously published studies in Portuguese, Spanish, English, and French have been included without any temporal limitation.
 Results: We included ten articles in the review. Nursing case management is focused on health services management, the centrality of patient/family care, and the case manager role.
 Conclusion: The studies included have low evidence levels and a limited sample size. The optimization of resources and services, the greater availability of time for the provision of care, and the satisfaction of the person and family with the care were highlighted. The role of the case manager is highlighted, proving to be very important throughout all the nursing case management.

Effectiveness of Plasmapheresis Treatment in the Treatment of Patients with COVID-19 Disease.

Background: According to the World Health Organization, COVID-19 management focuses primarily on infection prevention, case management, case monitoring, and supportive care. However, due to the lack of evidence, no specific anti-SARS-CoV-2 treatment is recommended. This study aimed to evaluate the effectiveness of plasmapheresis treatment in COVID-19 patients with symptoms of pulmonary involvement on the computed tomography (CT) of the lung. Methods: In 2021, an experimental study in critically ill patients admitted to the COVID-19 ward in the Hazrat-e Rasool hospital diagnosed with COVID-19 was conducted in the second phase (pilot study). The diagnosis was confirmed according to clinical signs, CT scan of the lung, and the Polymerase chain reaction (PCR) test. All patients received the usual treatments for COVID-19 disease and underwent plasmapheresis at a dose of 40 cc/kg daily up to 4 doses. All patients were observed for 24 hours for complications of plasmapheresis treatment and simultaneously for symptoms of COVID-19, after which only routine care measures were performed. The next day and 2 weeks after resumption of the treatment, patients experienced COVID-19 symptoms, including shortness of breath, cough, and fever. Blood oxygen saturation, and treatment results were evaluated. Qualitative and rank variables were described using absolute and relative frequencies and quantitative parametric variables were used using mean and confidence interval. Frequencies were compared in groups using the chi-square test. All tests were performed in 2 directions and P > 0.05 was considered statistically significant. Results: Of the 120 patients studied, 79 (65.8%) were men and 41 (34.2%) were women. The mean age was 60.30 ± 15.61 years (22-95 years). The mean hospital stay was 12.89 days ± 7.25 days (2-38 days). Increased blood oxygen saturation levels in patients had an increasing trend. Inflammatory indices had a downward trend in patients. The frequency of plasmapheresis had no significant effect on reducing the downward trend of inflammatory markers. The greatest reduction occurred in the first plasmapheresis. Conclusion: Finally, according to the findings, plasmapheresis is one of the appropriate treatments to improve patients' symptoms and reduce cytokine storm. Recovered patients had lower levels of inflammatory markers than those who died.

Do Integrated Hub Models of Care Improve Mental Health Outcomes for Children Experiencing Adversity? A Systematic Review.

This review assesses the effectiveness of integrated primary health and social care hubs on mental health outcomes for children experiencing adversity and describes common integration dimensions of effective hubs.PubMed, OVID Medline and PyschINFO databases were systematically searched for relevant articles between 2006–2020 that met the inclusion criteria: (i) interventional studies, (ii) an integrated approach to mental health within a primary health care setting, (iii) validated measures of child mental health outcomes, and (iv) in English language.Of 5961 retrieved references, four studies involving children aged 0–12 years experiencing one or more adversities were included. Most children were male (mean: 60.5%), and Hispanic or African American (82.5%).Three studies with low-moderate risk of bias reported improvements in mental health outcomes for children experiencing adversity receiving integrated care. The only RCT in this review did not show significant improvements.The most common dimensions of effective integrated hubs based on the Rainbow Model of Integrated Care were clinical integration (including case management, patient-centred care, patient education, and continuity of care), professional integration, and organisational integration including co-location.These results suggest hubs incorporating effective integration dimensions could improve mental health outcomes for children experiencing adversity; however, further robust studies are required.Registered with Prospero: CRD42020206015.

Primary health care case management through the lens of complexity: an exploratory study of naturopathic practice using complexity science principles

BackgroundAdvances in systems science creates an opportunity to bring a complexity perspective to health care practices and research. While medical knowledge has greatly progressed using a reductionist and mechanistic philosophy, this approach may be limited in its capacity to manage chronic and complex illness. With its holistic foundation, naturopathy is a primary health profession with a purported alignment with a complexity perspective. As such this pilot study aimed to investigate the application of complexity science principles, strategies, and tools to primary health care using naturopathy as a case study.MethodsA network mapping and analysis of the naturopathic case management process was conducted. Mind maps were created by naturopathic practitioners to reflect their clinical conceptualisation of a common paper clinical case. These mind maps were inputed into Gephi, a network mapping, exploration, and analysis software. Various layouts of the data were produced, and these were analysed using exploratory data analysis and computational network analysis.ResultsSeven naturopathic practitioners participated in the study. In the combined network mapping, 133 unique elements and 399 links were identified. Obesity, the presenting issue in the case, was centrally located. Along with obesity, other keystone elements included: systemic inflammation, dysbiosis, diet, the liver, and mood. Each element was connected on average to 3.05 other elements, with a degree variation between one and 36. Six communities within the dataset were identified, comprising: the nervous system and mood, gastroinstetinal and dietary factors, systemic inflammation and obesity, the endocrine system and metabolism.ConclusionsThis pilot study demonstrates that it is feasible to apply a complexity science perspective to investigating primary health care case management. This supports a shift to viewing the human organism as a complex adaptive system within primary health care settings, with implications for health care practices that are more cognisant with the treatment of chronic and complex conditions and research opportunities to capture the complex clinical reasoning processes of practitioners.

Case Management Improves Satisfaction, Anxiety, and Depression of Patients with Pregnancy Loss after In Vitro Fertilization and Embryo Transfer.

Objective Pregnancy loss has negative impacts on both the physical and the mental health of expectant mothers, which calls for an in-depth investigation. In this study, we examined the effects of case management on patients with pregnancy loss after in vitro fertilization and embryo transfer (IVF-ET). Methods 100 participants that had suffered pregnancy loss after IVF-ET-assisted pregnancy from January 2019 to March 2020 were divided into routine care and case management groups, each with 50 cases. For the routine care group, a doctor led the diagnostic and treatment processes and a nurse assisted with the treatment. For the case management group, a nurse led the patient diagnostic and treatment processes and a doctor controlled the diagnosis and treatment plan formulation. Case management models were established according to the comprehensive peripregnancy loss care of patients with pregnancy loss after IVF-ET-assisted pregnancy. The participants' outcomes (satisfaction, anxiety, and depression) were assessed at the time of pregnancy loss and 1 and 3 months after pregnancy loss during follow-up of the routine care and case management groups. Results There was no statistical difference between the patients in the two groups with regard to their general information statistics (P > 0.05) or their satisfaction, anxiety, and depression at the time of pregnancy loss (P > 0.05). One month after pregnancy loss, there was no statistical difference in anxiety between the two groups (P > 0.05), but satisfaction was greater and depression was significantly reduced in the case management group compared with the routine care group (P < 0.05). Conclusion Case management care can have a positive effect on improving the satisfaction, anxiety, and depression of patients that have had pregnancy loss after IVF-ET.

Long-term quality of integrated community case management care for children in Bugoye Subcounty, Uganda: a retrospective observational study

ObjectiveIntegrated community case management (iCCM) of childhood illness in Uganda involves protocol-based care of malaria, pneumonia and diarrhoea for children under 5 years old. This study assessed volunteer village health...