Context Of Care Research Articles

Application of Motivational Interviewing in climate-sensitive health counselling – A workshop report

IntroductionThis workshop report explores the application of Motivational Interviewing (MI) in Climate-sensitive Health Counselling (CSHC) within the context of primary health care. As there is a growing interest in the connection of individual health and climate change mitigation, we provide practical guidance on integrating MI techniques in CSHC. MethodsIn June 2023, a 2-day workshop on MI was conducted at the Institute of General Medicine, University of Cologne. The workshop, facilitated by a certified MI trainer, combined theoretical content with practical group exercises. In a second workshop the staff of the Institute of General Medicine discussed the application of MI in CSHC. ResultsWe identified and specified five tools to apply MI in CSHC: A) risk assessment scores, B) relevance assessment scales, C) decision matrices, D) confidence assessment scales, and E) SMART goals. These tools provide practical insights for integrating MI into primary care consultations, offering a time-efficient approach to CSHC. DiscussionOur results present a promising approach for healthcare professionals to incorporate climate-related aspects into health counselling of patients. Feasibility and effects of MI in CSHC are still unclear and require further research. ConclusionThe tools identified provide practical guidance for the application of MI in climate-sensitive health counselling (CSHC) as well as guidance on conducting appropriate studies.

Scoping review protocol: what is the state of evidence for the use of communication apps with immigrant seniors in long-term care and community settings?

First language care is critical for older immigrant adults with limited English proficiency, especially in long-term care settings where most residents require staff assistance and experience complex chronic conditions, resulting in multiple communication interactions where language poses a barrier. Although there are a myriad of cultural-language translation apps and devices available, there is a gap in both research and practice on the acceptability and feasibility of these digital resources within the context of long-term care and community settings for older immigrant adults, from a cultural relevance and digital health equity perspective. Our paper outlines a scoping review protocol to examine the state of the literature on the extent to which cultural-language translation apps are used in long-term care settings and community-based elder care. We will also examine the extent to which such apps bridge or further gaps in equitable, accessible and acceptable care for older immigrant adults with limited English language proficiency. This scoping review protocol will employ an adapted five-stage framework outlined by Arksey and O'Malley guided by enhancements recommended by Levac et al and Colquhoun et al. Using the Joanna Briggs Institute's population, concept and context framework, we defined the scope of the scoping review by identifying the target population, concepts for investigation and the context within which the research is situated. We will conduct a search of the literature from 2005 to 2024 using five bibliographic databases from health sciences (Healthstar OVID, MEDLINE OVID and Cumulative Index to Nursing and Allied Health Literature (CINAHL) EBSCO), engineering (Engineering Village Elsevier) and a cross-disciplinary database (Web of Science Clarivate). The research team will adopt a critical, equity-focused approach for the scoping review by integrating Richardson et al's framework for Digital Health Equity into our analysis of the findings. This will ensure that health and social equity perspectives are integrated within our methodology and analytical lens. Our analysis will specifically examine selected studies for their engagement with health equity and their ability to address issues such as ageism, ableism and the digital divide within geriatric care. Ethics approval is not required for this scoping review as it involves secondary analysis of published works and no primary data collection involving human subjects. Findings of the review will be shared with community partners and disseminated through publications, conferences and peer-reviewed publications.

Assessing the maturity of integration of health and social care in Finland – findings from a pilot study

PurposeIntegrated care is the leading approach to developing health and social care services in Finland. After the national health and social care reform, the importance of assessing integration has been emphasized. The aim of this study was to pilot the SCIROCCO tool, which assesses integration maturity, in Finland. The SCIROCCO tool was translated and adapted to the Finnish health and social care context. The feasibility and utility of this tool for assessing the maturity for integration across health and social care in Finland were evaluated using empirical pilot data collected among employees of selected well-being service counties. The study also provided baseline information on the maturity of integration after the national health and social care reform.Design/methodology/approachEmployees (n = 111) of different personnel groups in health and social care services in four well-being service counties assessed the maturity of integration using a web-based survey. A pilot study design was used.FindingsThe SCIROCCO tool was found to be useful for assessing the maturity of integration in health and social care within the well-being service counties. However, the tool requires further development to be fully adapted to the Finnish health and social care system and to assess integration across sectors. The results emphasize the need to understand the perspectives of different personnel groups on integration and to consider them in the development work.Originality/valueThis was the first study conducted in Finland that provided valuable insights into the assessment of integration across the health and social care sectors. This study establishes the foundation for future research and development in the field of integration assessment.

Patient-related factors impact the implementation of inpatient antibiotic allergy delabeling

BackgroundThe clinical consequences of an antibiotic allergy label (AAL) are detrimental impacting health care delivery and patient outcomes. We assessed hospital inpatients with intent to offer free AAL assessment within a randomised controlled trial (RCT). ObjectiveTo determine the feasibility of establishing an adult antibiotic allergy delabeling service in a Western Australian tertiary public hospital. MethodsInpatients (N=1503) with AAL were identified through medical records and screened for eligibility to participate in an RCT. Those recruited were randomised to undergo assessment by skin testing +/- oral challenge, or direct oral challenge. A control group received usual care. ResultsOf the 1503 inpatients with an AAL, 429 (28.5%) were eligible for AAL assessment. The primary excluding factor (1,074, 71.5%) was contraindicated medication use (387, 36.0%), followed by cognitive impairment (298, 27.9%). Thirty-nine patients were randomised, 20 received allergy testing and 19 usual care; all patients were followed up for 5 years. Older patients were less likely to be eligible (10- year increase: OR = 0.82, 95% CI = 0.77-0.88, p<0.0001); whilst surgical patients were more likely to be eligible than medical patients (OR = 2.49, 95% CI = 1.97-3.16, p<0.0001). ConclusionsAntibiotic allergy delabeling in the acute care context is not straightforward. Competing clinical concerns and patient acceptance are some barriers to an inpatient service. Nor is it apparent that inpatient vs outpatient testing is cost saving although select patient groups may benefit. Testing younger people and those with predicted high antibiotic usage will derive maximal individual and health system benefits.

Using Physiological Biomarkers to Optimize Management of TBI in Austere Environments.

Multimodal monitoring is the use of data from multiple physiological sensors combined in a way to provide individualized patient management. It is becoming commonplace in the civilian care of traumatic brain-injured patients. We hypothesized we could bring the technology to the battlefield using a noninvasive sensor suite and an artificial intelligence-based patient management guidance system. Working with military medical personnel, we gathered requirements for a hand-held system that would adapt to the rapidly evolving field of neurocritical care. To select the optimal sensors, we developed a method to evaluate both the value of the sensor's measurement in managing brain injury and the burden to deploy that sensor in the battlefield. We called this the Value-Burden Analysis which resulted in a score weighted by the Role of Care. The Value was assessed using 7 criteria, 1 of which was the clinical value as assessed by a consensus of clinicians. The Burden was assessed using 16 factors such as size, weight, and ease of use. We evaluated and scored 17 sensors to test the assessment methodology. In addition, we developed a design for the guidance system, built a prototype, and tested the feasibility. The resulting architecture of the system was modular, requiring the development of an interoperable description of each component including sensors, guideline steps, medications, analytics, resources, and the context of care. A Knowledge Base was created to describe the interactions of the modules. A prototype test set-up demonstrated the feasibility of the system in that simulated physiological inputs would mimic the guidance provided by the current Clinical Practice Guidelines for Traumatic Brain Injury in Prolonged Care (CPG ID:63). The Value-Burden analysis yielded a ranking of sensors as well as sensor metadata useful in the Knowledge Base. We developed a design and tested the feasibility of a system that would allow the use of physiological biomarkers as a management tool in forward care. A key feature is the modular design that allows the system to adapt to changes in sensors, resources, and context as well as to updates in guidelines as they are developed. Continued work consists of further validation of the concept with simulated scenarios.

Enhancing psychological support and communication in intensive care unit data transmission

Dear Editor, We have read with great attention and interest the article "Clinical data transmission in intensive care unit: what have we learned from COVID-19?"1 by Pota et al. We believe that the authors have addressed a very important clinical and ethical aspect regarding the transmission of clinical data. The pandemic has taught us that unforeseen emergent events are still possible and that the global healthcare and economic systems may not be adequately prepared to respond. We agree that, to date, there is no precise regulation on the transmission of patient-related clinical data to families. This includes challenges such as identifying the appropriate recipient, the lack of qualified personnel for medical communication, and the use of uncertified channels that neglect data protection regulations. Additionally, we wish to draw attention to another crucial aspect: psychological support. Healthcare personnel often find themselves communicating severe clinical evaluations and sometimes unfavorable treatment outcomes. Some of the main challenges faced daily by operators in intensive care contexts involve continuous exposure to severe physical and psychological suffering, navigating uncertainty and unpredictability, and balancing the needs of the patient with those of their family. The complexity of current technological aspects introduces new challenges in this scenario.2 The lack of in-person communication could weaken the trust and empathy that should exist between healthcare personnel and the family. [...]

Exploring the development of narrative identities in emerging adults who have been in foster care

Foster care involvement is often marked by being in a frequent state of disruption, resilience, disempowerment, and self-protection (e.g., Mitchell, 2016). Although over 400,000 children are in foster care at any given time in the U.S. (Children’s Bureau, 2021), foster youth are a relatively understudied population, especially regarding their own meaning-making and the development of their sense of self. The purpose of the present study was to understand the psychological experiences that shape the construction of self-narratives in young adults who have been in foster care. The sample included nine young adults (18–24 years old) who had been in foster care at some point in their childhood; all participants identified as women. The sample was diverse in terms of racial and ethnic identities. Participants completed brief surveys and an interview regarding their background, foster care experiences, and hopes for the future. Data were analyzed using reflexive thematic analysis. Study findings highlighted how foster youth navigated uncertainty, instability, and isolation in their interpersonal relationships, as well as ambiguity in understanding their past, present, and future. Findings further highlighted the process of managing dialectics throughout development, especially regarding adverse experiences, and how youth are shaped by their past to create their future. While these themes were not exhaustive of the complete process of self-narrative development, they did provide a starting point for understanding and empowering foster youth to own their stories. The primary implication of this study is that the unique developmental context of foster care shapes the self-narrative processes and meaning-making experiences of youth.

From passive subjects to active agents: enabling child-centred recordkeeping in social care contexts

ABSTRACT This paper describes the findings and implications of interdisciplinary exploratory research conducted by social work and recordkeeping informatics researchers in Australia and the UK. It sought to identify the practices, systems, education and technologies that can foster rights-based, child-centred recordkeeping practices in child protection contexts, exploring the transformation and advocacy work that could be achieved in child protection case note recording and recordkeeping practices and systems through interdisciplinary collaborations. Drawing from qualitative interviews, focus groups and surveys with Social Work students, Social Work educators and practice educators, and with practitioners working in children’s social care (in England) and the child protection services system (in Australia), we identify how practitioners are prepared for keeping records that reflect children’s voices and experiences, and identify emerging best practices and persistent challenges. Focusing on the intersection of child rights, archival ethics, and participatory approaches, this paper adds to the discourse on critical archival studies concerning children and calls for an interdisciplinary approach to reimagine future possibilities for participatory and child-centred practice in which children are not just passive subjects but active collaborators in the recordkeeping process.

Gamified Mobile App (MobERAS) for Telemonitoring Patients in the Postoperative Period Based on the Enhanced Recovery after Surgery Program: Development and Validation Study.

Digital technology and gamified apps can be useful in the health care context. Gamification uses technology to influence users' actions and motivations through experiences that resemble games. Patient adherence to the enhanced recovery after surgery (ERAS) program is crucial for achieving early recovery after surgery and continuous monitoring is essential for obtaining good results. This study aimed to describe the development and validation of a mobile app for enhanced recovery after surgery (MobERAS), a gamified mobile health app for telemonitoring patients in the postoperative period based on the ERAS program, and to evaluate its functionality and usability and the experience of patients, health care professionals, and computer professionals with its use. We developed MobERAS for postoperative telemonitoring, with active participation of patients in the process, and offering availability of real-time information for the health team. The app development process included idealization, interdisciplinary team formation, potential needs assessment, and product deployment. Usability tests were conducted throughout the development process with improvements, technical adjustments, and updates. After finalization, comprehensive verification tests were performed. The parameters evaluated are those that can influence the length of hospital stay, such as nausea, vomiting, pain scales, return to normal gastrointestinal function, and thromboembolic events. MobERAS was designed to be downloaded by users on their phones, tablets, or other mobile devices and to provide postoperative data. The app has a GPS that monitors the patient's walking time and distance and is connected to a virtual database that stores the collected data. Women undergoing medium and major gynecologic oncologic surgeries were included. We included 65 patients with an average age of 53.2 (SD 7.4, range 18-85) years. The time of use ranged from 23.4 to 70 hours (mean 45.1, SD 19.2 hours). Regarding adherence to the use of MobERAS, the mean fill rate was 56.3% (SD 12.1%, range 41.7%-100%), and ambulation data were obtained for 60 (92.3%) of the 65 patients. The researcher had access to the data filled out by the patients in real time. There was good acceptance of the use of MobERAS by the patients, with good evaluation of the app's usability. MobERAS was easy to use and considered attractive because of its gamified design. The app was rated as good or very good in all items by health care professionals (n=20) and professionals specializing in technological innovation (n=10). MobERAS is easy to use, safe, well accepted by patients, and well evaluated by experts. It can be of great use in clinical surgical practice and an important tool for greater engagement of patients and health care professionals with the ERAS program.

Sensitivity and specificity of Aboriginal-developed items to supplement the adapted PHQ-9 screening measure for depression: results from the Getting it Right study.

To determine the psychometric properties of an Aboriginal and Torres Strait Islander-developed depressive symptom screening scale. Prospective diagnostic accuracy study. Ten primary health care services or residential alcohol and other drug rehabilitation services in Australia that predominantly serve Aboriginal and Torres Strait Islander peoples. 500 adults (18 years or older) who identified as Aboriginal and/or Torres Strait Islander and were able to communicate sufficiently to respond to questionnaire and interview questions. Recruitment occurred between 25 March 2015 and 2 November 2016. Criterion validity of seven Aboriginal and Torres Strait Islander-developed items, using the adapted Patient Health Questionnaire 9 (aPHQ-9) and depression module of the Mini International Neuropsychiatric Interview (MINI) 6.0.0 as the criterion standards. The seven-item scale had good internal consistency (α=0.83) and correlated highly with the aPHQ-9 (ρ=0.76). All items were significantly associated with diagnosis of a current major depressive episode. Discriminant function and decision tree analysis identified three items forming a summed scale that classified 85% of participants correctly. These three items showed equivalent sensitivity and specificity to the aPHQ-9 when compared with the MINI-identified diagnosis of a current major depressive episode. Three items developed by and for Aboriginal and Torres Strait Islander people may provide effective, efficient and culturally appropriate screening for depression in Aboriginal and Torres Strait Islander health care contexts.

Older patients want to talk about sexual health in Australian primary care

Background Maintaining sexual health and function is important to many older adults. Although older patients are regular users of primary care, opportunities to address sexual health concerns are missed. Building on interview studies, this research aimed to collect a larger number of older adults’ perspectives to deepen understanding of sexual healthcare needs and formulate recommendations for the Australian primary care context. Methods As part of the SHAPE2 Survey of older adults’ sexual health information-seeking behaviours, participants (aged ≥60 years and living in Australia) were asked what sexual health issues were most important to them, and the barriers they experienced in managing their sexual health. Data were collected in 2021 in the form of free-text comments. The sub-set of comments that related to healthcare experiences were analysed using qualitative content analysis. Results Out of 1470 survey participants, 864 responded to the relevant questions, and of these 107 wrote about healthcare experiences. Some comments described positive experiences seeking sexual health care; however, the majority outlined barriers to accessing support. Barriers were categorised into seven categories: patient embarrassment, barriers to rapport, uncertainty about finding solutions, ageism, barriers unique to minorities, needing general practitioners to initiate conversations and structural barriers. Conclusions Older patients want general practitioners to initiate sexual health conversations as part of routine care, and, crucially, sexual issues raised by the patient should be legitimised and treated with due attention. Although challenges, such as time, embarrassment and pressing health concerns, may hamper sexual health discussions, it is important that this area of holistic care is given more attention.

Regional variation in health care substitution for intrauterine device insertion: a retrospective cohort study

BackgroundRising health care costs are a major concern in most Western countries. The substitution of healthcare stands as a strategic approach aimed at mitigating costs while offering medical services in proximity to patients’ residences. An illustrative instance involves the migration of outpatient hospital care to primary care settings. Notably, the insertion of intrauterine devices (IUDs) can be safely executed within primary care contexts. In order to establish a pragmatic objective for the rate of IUD substitution, we conducted an evaluation of regional disparities in healthcare substitution pertaining to the insertion of intrauterine devices. Furthermore, we investigated disparities in the follow-up ultrasound and reinsertion of IUDs between primary and secondary healthcare environments.MethodsAll women who underwent IUD insertion in Dutch primary care (by general practitioners and midwives) and secondary care (by hospital physicians) between January 1, 2016, and December 31, 2020 were included. The main outcome measures were the case-mix adjusted IUD insertion rates at the regional level by care setting and the proportions requiring follow-up ultrasound and IUD reinsertion within three months.ResultsOf the 840,766 IUD placements, 74% were inserted in primary care and 26% in secondary care. The proportion inserted in primary care increased from 70% in 2016 to 77% in 2020. The observed substitution rate ranged from 58 to 82% between regions. Compared with health care professionals in primary care, those in secondary care performed more ultrasounds to verify IUD placement (23% vs. 3%; p-value < 0.01) and more IUD reinsertions within three months (6% vs. 2%; p-value < 0.01).ConclusionsIUDs are increasingly being inserted in Dutch primary care, with peak regional IUD insertion care substitution rates at ≥ 80%. IUD insertion care substitution to primary care appears to be associated with significantly fewer women having follow-up ultrasound or IUD reinsertion within three months.

Applying models of co-production in the context of health and well-being. A narrative review to guide future practice.

Recent years have seen a dramatic growth in interest in the nature and extent of co-production in the health and social care sectors. Due to the proliferation of work on co-production, there is variation in practice in how co-production is defined, understood, and used in practice. We conducted a narrative review to explore, and provide an overview of, which models of health and social care co-production have been developed, applied, and critiqued over recent decades. Seventy-three peer-reviewed articles met our inclusion criteria. In this set of articles, we identified three broad types of models: conceptual/theoretical, practice-oriented, and presenting a typology. We found that practice-oriented models, predominantly from the Health Services Research and Quality Improvement literature, had largely not drawn on conceptual/theoretical models from the disciplinary fields of Public Administration & Management and Sociology. In particular, they have largely neglected theoretical perspectives on relationships and power and agency in co-production work. The concepts of Service-Dominant Logic and Public Service-Dominant Logic as ways to think about the joint, collaborative process of producing new value, particularly in the context of the use of a service, have also been neglected. Our review has identified distinct literatures which have contributed a variety of models of health and social care co-production. Our findings highlight under-explored dimensions of co-production that merit greater attention in the health and social care contexts. The overview of models of co-production we provide aims to offer a useful platform for the integration of different perspectives on co-production in future research and practice in health and social care.

Women's views and experiences of breastfeeding during the coronavirus disease 2019 pandemic: A systematic review of qualitative evidence.

The coronavirus disease 2019 pandemic affected breastfeeding women in various ways. Understanding their experiences during the pandemic is crucial for informing actionable recommendations, evidence-based strategies and future policies to support breastfeeding during global pandemics. This review aimed to synthesise qualitative evidence on women's breastfeeding perceptions, experiences and support needs during the pandemic. The Joanna Briggs Institute's (JBI) guidelines on systematic reviews of qualitative evidence were followed. MEDLINE, Embase, CINAHL and Web of Science Core Collection databases were searched. Methodological quality of included papers was assessed using JBI's checklist for qualitative research. The synthesised findings were generated using JBI's meta-aggregation approach. The JBI ConQual process was used to rank each synthesised finding. Fifty-two papers were included. The synthesised findings included: (1) women's awareness and commitment to breastfeeding during the pandemic, (2) the multifaceted breastfeeding experiences of women during the pandemic, (3) breastfeeding practices and challenges for working women, (4) professional support during the pandemic: navigating breastfeeding in an evolving health care context and (5) family and peer support groups during the challenging times of the pandemic. Breastfeeding women require clear information, accessible in-person lactation support, family emotional support, food security and protection of psychological well-being. The review reported diverse breastfeeding experiences, from social support challenges to positive aspects like remote work. Breastfeeding support and lactation consultants should be considered as essential services in future pandemics. Food security is crucial for breastfeeding households. Lactation services could prioritise face-to-face consultations for physical challenges and providing online informational support. Future research could explore innovative breastfeeding education strategies.

Supporting the Primary Care Workforce Through Training in Advanced Generalist Practice: An Evaluation of the Catalyst Program.

As a workforce crisis is causing recruitment and retention issues for new to practice GPs, we designed Catalyst, a one-year pilot career development program aiming to help new to practice GPs develop the skills of advanced generalist practice and build capacity for the complex work of primary care. In this paper, we report the findings of our evaluation of Catalyst. We used normalization process theory to investigate how Catalyst was contributing to the participants' understanding and implementation of generalist practice. We conducted 36 interviews and six focus groups investigating the participants' clinical practice and experience with the program and analyzed data using framework analysis. Establishing a shared language and reframing professional identity helped GPs develop an understanding of their role through generalist lenses. Generalist practice was legitimized by access to scientific evidence and facilitated interactive learning. Integration of scientific, applied knowledge and quality improvement work fostered the enactment of such practice. Structured reflection and research-informed quality improvement projects contributed to the participants' awareness of the primary care context. Knowledge creation activities observed through interactive learning and the integration of different types of knowledge facilitated the implementation of advanced generalist practice. The participants valued the community of practice gained through the program and would come to rely on programs designed to encourage networking and enable peer support. Finally, research-informed quality improvement projects built to analyze problems and monitor solutions are crucial for an early career physician to develop a sense of agency that shapes their primary care practice.

Creating indoor learning areas to implement the Early Childhood Care and Education Curriculum

Background: A safe and inclusive indoor learning environment reflects different ways of knowing, actuality and thinking. In the Early Childhood Care and Education (ECCE) context, indoor learning areas influence the exploration of teaching and learning activities.Aim: This article explored rural ECCE teachers’ experiences of creating indoor learning areas as required by the National Curriculum Framework (NCF) for children from birth to 4 years.Setting: Six purposively selected teachers from the three rural ECCE centres in KwaZulu-Natal province that transitioned to using the NCF participated in the study.Methods: A qualitative case study located within the interpretive paradigm was employed. Data that were inductively analysed were collected through semi-structured interviews with two teachers in each of the three centres. Transformative learning theory underpinned the study.Results: The study found that six teachers who desired to learn from each other engaged in a collaborative learning venture within their centres and complied with the NCF to create indoor learning areas in the interest of young children.Conclusion: The study argues that teachers shifted their insights from the challenges to achieving the objectives of the NCF. Thus, it questioned the assumption that rural teachers lack the knowledge to design learning areas.Contribution: Rural ECCE teachers are committed to learning for the development of young children.

Meeting the Needs of Emerging Adults With Type 1 Diabetes Living in a Rural Area With Mobile Health Interventions: Focus Group Study.

Emerging adults (EAs; age 18-30 years) with type 1 diabetes (T1D) have more challenges with diabetes management and glycemic control than other age groups. Living in a rural community introduces additional unique diabetes care challenges due to limited access to specialty care and ancillary support services. Yet, few interventions have been developed to improve diabetes management in rural-dwelling EAs with T1D. This study aimed to understand the diabetes management experiences of older adolescents and EAs (age 16-25 years) with T1D living in a rural area and to assess their perceptions of the acceptability of 4 fully automated mobile health (mHealth) interventions to support diabetes management. EAs were identified by clinical staff through convenience sampling. In total, 8 EAs participated in 1 focus group and 1 EA completed an individual interview; all data were collected over Zoom. Facilitators explored EAs' experiences living in a rural community with T1D and discussed EAs' impressions of, feedback on, and recommendations for improving 4 mHealth interventions to meet the specific needs of EAs with T1D living in rural communities. Discussions were transcribed and analyzed using conventional content analysis. In total, 9 EAs (aged 18.8, SD 2.7 years; 5, 56% men; 8, 89% White) with a duration of diabetes of 8.6 (SD 4.3) years participated. They described experiences with diabetes stigma (attributing diabetes to poor lifestyle choices) and feelings of self-consciousness (hyperawareness) in their rural communities. They attributed these experiences to the small size of their communities ("everyone knows") and community members' lack of knowledge about diabetes (unable to differentiate between type 1 and type 2 diabetes). In contrast, EAs reported high levels of social support for diabetes and diabetes care from family, friends, and other community members, but low support for medical needs. The location of their diabetes care providers and the limited accessibility of diabetes-specific and general medical care services in their local community created a challenging medical care context. Overall, EAs found mHealth interventions appealing due to their digital delivery and highlighted features that increased accessibility (voiceovers and simple, jargon-free language), individualization (ability to tailor intervention content and delivery), and applicability to their own lives and other EAs with T1D (relatability of vignettes and other content). EAs suggestions for improving the interventions included more opportunities to tailor the interventions to their preferences (greater frequency and duration, ability to adapt content to emerging needs), increasing opportunities for peer support within the interventions (friend and significant other as identified support person, connecting with peers beyond their local community), and making the tone of intervention components more casual and engaging. mHealth interventions aligned with EAs' needs and preferences are a promising strategy to support EAs in communities where social support and resources might be limited. N/A, not a clinical trial.

Is a Problem-Solving Intervention with Workplace Involvement for Employees on Sickness Absence Due to Common Mental Disorders More Effective, than Care as Usual, in Reducing Sickness Absence Days? Results of a Cluster-Randomised Controlled Trial in Primary Health Care.

The aim was to evaluate the effectiveness of a problem-solving intervention with workplace involvement (PSI-WPI) added to care as usual (CAU) in reducing sickness absence days among employees with common mental disorders compared to CAU alone in Swedish primary health care on a monthly basis over 18-months follow-up. We conducted a cluster-randomised controlled trial including 197 employees blinded to allocation (85 PSI-WPI and 112 CAU). As sickness absence data was skewed and over-dispersed, generalised estimating equations was used to enable a comparison between the intervention and control group for each month of the follow-up period. The median number of sickness absence days over the 18-month follow-up was 78 days, inter-quartile range (IQR) 18-196 for employees receiving PSI-WPI and 64 days, IQR 18-161 for employees receiving CAU. The time x group generalised estimating equations analysis showed no statistically significant difference in sickness absence days per month. The addition of a PSI-WPI to CAU was not more effective in reducing sickness absence days. This may be explained by the primary health care context, lack of specialisation in occupational health and the Swedish social insurance system with specific time limits. The trial was registered at ClinicalTrials.gov, identifier: NCT03346395 on January 12th, 2018.

Transformation of primary care settings implementing a co-located team-based care model: a scoping review

BackgroundIn Canada, primary care reforms led to the implementation of various team-based care models to improve access and provide more comprehensive care for patients. Despite these advances, ongoing challenges remain. The aim of this scoping review is to explore current understanding of the functioning of these care models as well as the contexts in which they have emerged and their impact on the population, providers and healthcare costs.MethodsThe Medline and CINAHL databases were consulted. To be included, team-based care models had to be co-located, involve a family physician, specify the other professionals included, and provide information about their organization, their relevance and their impact within a primary care context. Models based on inter-professional intervention programs were excluded. The organization and coordination of services, the emerging contexts and the impact on the population, providers and healthcare costs were analysed.ResultsA total of 5952 studies were screened after removing duplicates; 15 articles were selected for final analysis. There was considerable variation in the information available as well as the terms used to describe the models. They are operationalized in various ways, generally consistent with the Patient’s Medical Home vision. Except for nurses, the inclusion of other types of professionals is variable and tends to be associated with the specific nature of the services offered. The models primarily focus on individuals with mental health conditions and chronic diseases. They appear to generally satisfy the expectations of the overarching framework of a high-performing team-based primary care model at patient and provider levels. However, economic factors are seldom integrated in their evaluations.ConclusionsThe studies rarely provide an overarching view that permits an understanding of the specific contexts, service organization, their impacts, and the broader context of implementation, making it difficult to establish universal guidelines for the operationalization of effective models. Negotiating the inherent complexity associated with implementing models requires a collaborative approach between various stakeholders, including patients, to tailor the models to the specific needs and characteristics of populations in given areas, and reflection about the professionals to be included in delivering these services.

Experience of caregivers and healthcare professionals using a telemedicine programme in a paediatric palliative care unit.

Telemedicine is a means of providing efficient treatment for children with complex chronic conditions and/or subsidiary palliative paediatric care. To evaluate how satisfied families and healthcare professionals are with a telemedicine programme. This is a qualitative study of narrative design. Ten interviews were conducted with family members and professionals who had been using telemedicine for a year. Sampling was intentional and a discourse and content analysis was conducted. Six thematic categories emerged from the analysis of the interviews: degree of satisfaction; usefulness; benefits according to patient needs and attention; technical and human difficulties; and implantation of the system and proposals for improvement. The study shows that telemedicine is a very useful complementary tool for healthcare professionals in a palliative care context. It is necessary to take into account the perception and needs of both families and healthcare professionals with regard to this tool since it can improve patient care.