Care System Changes Research Articles

Perception and Acceptance of Telemedicine Use in Health Care Among the General Public in China: Web-Based Cross-Sectional Survey.

The COVID-19 pandemic is bringing about substantial changes in health care systems, leading to a significant shift toward telemedicine for the delivery of health care services. This study aims to examine the relationship between perceived usefulness and ease of use of telemedicine services and their association with the behavioral intention to use telemedicine. An anonymous cross-sectional survey was conducted in China. Partial least squares structural equation modeling was used to determine significant predictors of intention to use telemedicine consultation. Types of illnesses that favored seeking telemedicine consultation, as well as the most preferred platform for conducting telemedicine consultations, were also investigated. In total, 1006 participants completed the survey. A total of 44.3% (n=446) reported being very likely and 49.3% (n=496) reported being likely to seek telemedicine consultation. Overall, the majority of participants expressed strong agreement or agreement regarding the perceived usefulness of telemedicine. Likewise, the majority indicated strong agreement or agreement when it came to their perception of the ease of using telemedicine. In the partial least squares structural equation modeling, perceived usefulness (β=0.322; P<.001) and perceived ease of use (β=0.118; P=.01) were significantly associated with a higher likelihood of seeking telemedicine consultation. A considerable number of participants expressed willingness to use telemedicine services for various medical conditions, particularly respiratory (n=340, 33.8%), skin (n=316, 31.4%), and musculoskeletal issues (n=316, 31.4%) while showing less interest in seeking telemedicine consultations for reproductive health (n=44, 4.4%) and cancer (n=64, 6.4%). The majority preferred video chat (n=443, 44%) and text chat (n=317, 31.5%) as their most preferred platforms for telemedicine consultation, while a smaller proportion preferred telephone (n=193, 19.2%) and email (n=53, 5.3%). Telemedicine has the potential to play a larger role in China's health care system. The preferences for certain platforms over others may influence service design and implementation.

Necessary, burdensome, or threatening? Awareness of Black-White disparities in health care access and self-rated health for Black and White Americans.

Awareness of racial health care inequities is one prerequisite to eliminating them. Although extant research has described awareness of racial health care inequities in the United States, the health impacts of such awareness on communities that are most impacted by these inequities remains unknown. Therefore, we examined associations between awareness of Black-White racial health care inequities and self-rated health for Black and White adults in the United States. We used survey data from non-Hispanic Black and White participants (N = 6,449) who responded to the national American Health Values Survey (2015-2016) to test associations between awareness of Black-White inequities in health care and self-rated health. Accurate awareness of health care inequities was associated with 47% higher odds of poorer self-rated health for Black individuals. Inaccurate awareness was associated with 36% higher odds of poorer self-rated health for White individuals. Accurate awareness may be adaptive, yet place an additional burden on Black individuals. Inaccurate awareness may harm White individuals' health. Health care system changes and alleviation of racism-related stress may be preventive supports for the health of Black individuals. Accurate awareness should be a goal for White individuals, not only to prevent health risks, but to also facilitate structural change for racial equity. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Health care use experiences of ethnoculturally diverse immigrant older adults: a meta-ethnography

PurposeCurrent and predicted continued dramatic increases in international migration and ethnocultural diversity of older adult cohorts pose challenges for health care services. Review studies on ethnoculturally diverse older adults and health care show a lack of focus on their service use experiences. This study aims to report a meta-ethnography that addresses this knowledge gap through answering the review question: How do ethnoculturally diverse older adults who are immigrants experience health careservices?Design/methodology/approachThe authors applied a seven-phase method of meta-ethnography to guide the review. The authors conducted two literature searches (April 2018 and June 2020) in MEDLINE, CINAHL, Embase, Sociological s and s in Social Gerontology that yielded 17 papers eligible for review.Findings“There’s always something positive and something negative” is the overarching metaphor for answering the review question. Findings highlight positive and negative tensions within ethnoculturally diverse older adults’ health care use experiences of understanding and being understood, having trust in providers and the health care system, having needs, preferences and resources met and desire for self-care over dependency. The majority of experiences were negative. Tipping points towards negative experiences included language, fear, provider attitudes and behaviours, service flexibility, attitudes towards Western and traditional health care and having knowledge and resources.Originality/valueThe authors propose concrete actions to mitigate the tipping points. The authors discuss policy recommendations for health care system changes at the micro, meso and macro service levels to promote positive experiences and address mainstream service policy inequities.

Shared medical decision in prostate cancer screening in primary care: a systematic literature review of current evidence.

Prostate cancer screening has not significantly reduced mortality. International guidelines strongly endorse shared decision-making to navigate risks, emphasizing its crucial role prior to prescribing a prostate-specific antigen test. This study aims to provide insight into the current role of shared decision-making in primary care for prostate cancer screening and suggest ways to improve the process. PubMed, Cochrane, and Lissa databases were searched for following terms: 'prostate-specific antigen' or 'prostate cancer screening' combined with 'shared decision making', 'informed decision making' or 'decision support' and 'primary care'. All studies were screened by two independent reviewers. This systematic review followed the PRISMA guidelines. Of 85 articles screened, 34 were included. Key findings included heterogenous and poor quality implementation of shared decision-making in practice, patients with limited knowledge of shared decision-making, clinicians infrequently discussing patients' views, decision aids that could be better integrated into practice, and finally, changes in care systems to support the expansion of shared decision-making in prostate cancer screening. Decision aids are essential tools in the informed decision-making process. Integrating these elements into practice would require training for doctors and adjustments to the healthcare system.

Портрет регионального министра здравоохранения – 2022

The heads of regional executive authorities in the sphere of health protection are key figures in the realization of the Russian Federation’s healthcare development strategy. Without qualified managers, it is difficult to achieve national goals and objectives of federal projects. The study of the qualifications, professional experience, and skills of the high leaders of regional health systems allows the evaluation of top personnel’s human potential and the successful implementation of steps to increase the efficiency of its administration. T h e a i m o f t h e s t u d y was to give a detailed information about regional health authorities managers in Russian Federation. M a t e r i a l s a n d m e t h o d s . A single-stage, continuous sociological study was planned and carried out using a specially developed questionnaire, which included a characterization of the accounting characteristics of participants’ age and demographic characteristic, level of basic and additional education, availability of professional competencies, and work experience in managerial positions. R e s u l t s . We achieved a response from 85 respondents. It was found that, as compared to 2021, there was a slowdown inside the process of rotation of regional ministers’ personnel and an increase in the degree of professional qualifications of managers in 2022. These trends were reflected in the increase in the average length of service in the position of regional minister (2021 2,1±1,9 years; 2022 2,6±2,5 years), the doubling of the number of managers with work experience of up to one year (2021 n = 42; 2022 n = 21), and the decrease in the number of managers with work experience of up to one year (2021 n = 42; 2022 n = 21). C o n c l u s i o n . The research allows for an assessment of the dynamics of changes in regional health care systems in terms of managerial human resources from 2021 to 2022. Positive declining trends in 2022 have been identified. The pace of rotation of regional ministers’ staff adds to the development of leaders’ professional abilities and experience and, eventually, will be the key to accomplishing strategic goals in health care.

Optimizing Medicaid Extended Postpartum Coverage to Drive Health Care System Change.

With recent changes in federal law, states now have an opportunity to improve maternal postpartum health and survival by extending postpartum coverage to 1 full year for all people with Medicaid financing during pregnancy. Every state has an opportunity to use additional financing to increase quality and equity in maternal health care and improve postpartum health for their Medicaid populations. This commentary discusses leverage points and potential areas for state, community, and clinical action.

Consumption of Antibiotics in Primary Care Setting before and during COVID-19 Pandemic in Republic of Srpska, Bosnia and Herzegovina.

The pandemic of COVID-19 has brought many changes in health care systems at all levels of health care. The increase in the number of cases of COVID-19 has led to overuse and misuse of antibiotics.The aim of this study was to compare the consumption of antibiotics for systemic use in outpatients in the Republic of Srpska (RS), before and during the first year of the COVID-19 pandemic, as well as the association between antibiotic consumption and the rate of incidence and mortality of COVID-19. The total consumption of the antibiotics for systemic use (J01) in outpatients in the Republic of Srpska during 2019 was 19.40 DDD/TID, with an increase to 30.80 DDD/TID in 2020.Significantly higher use of penicillin (10.58 ± 11.01 DDD/TID in 2019 vs. 17.10 ± 13.63 DDD/TID in 2020), cephalosporins (2.68 ± 1.90 DDD/TID in 2019 vs. 5.93 ± 2.77 DDD/TID in 2020) and macrolides (2.14 ± 2.22 DDD/TID in 2019 vs. 3.40 ± 3.44 DDD/TID in 2020) was observed during the pandemic period. It is necessary to improve the prescribing practice of antibiotics at the primary health care level, public awareness about rational use of antibiotics, as well as the current antibiotic stewardship programs and control their implementation.

Employing Family Caregivers: An Innovative Health Care Model.

Employing Family Caregivers: An Innovative Health Care Model.

The Relationship between Self-Efficacy, Self-Care Behavior, and Generalized Anxiety Disorder in COVID-19: A Path Analysis Model

Background: The outbreak of the COVID-19 pandemic has a strong impact on individuals and becomes a very stressful period. Long-term exposure to stress due to lockdown scenario may also increase psychological distress by reducing support resources, and in these circumstances, personal resources such as self-efficacy and its relationships appear important. It is important to explore people’s beliefs about their capabilities to produce designated levels of behavior in the face of COVID-19, which is not known in the target population, and also to show its effect on anxiety.Purpose: This study aimed to investigate the relationship between self-efficacy, self-care behavior, and generalized anxiety disorder in COVID-19.Methods: A cross-sectional online survey was performed after COVID-19 was confirmed in Iran. The population of the study was 500 residents in a province in Iran that were randomly selected. Demographic data, general self-efficacy, self-care behavior, and the Generalized Anxiety Disorder (GAD-7) questionnaires were used for data collection. The data were analyzed using bivariate correlation and hierarchical linear regression models by using the SPSS statistical version (V.20).Results: The mean(SD) of age participants was 31.9(11.9). Their GAD-7 scores had severe anxiety (score ≥17). There was a negative and significant relationship between generalized anxiety disorder and self-efficacy (r=-0.238, p≤0.01). Also, there was a positive and significant relationship between self-efficacy and self-care behavior. No significant relationship between generalized anxiety disorder and self-care behavior was found. The path analysis model estimated anxiety and self-efficacy as about 4% of the variance self-care behavior in COVID-19.Conclusion: This study revealed that enhancing self-efficacy levels might reduce anxiety. Self-efficacy-enhancing programs should be used as part of the routine readiness effort drives and health care system change.

Knowledge of and Barriers to Palliative Care Perceived by Healthcare Providers before and after Promotion of the Patient Autonomy Act: A Cross-Sectional Study.

This study was designed to investigate healthcare providers’ knowledge of palliative care and perceptions of palliative care barriers before and after promoting the Patient Autonomy Act (PAA). A convenience sample was recruited, including 277 healthcare providers in 2013 and 222 healthcare providers in 2018. Multivariate linear regression analyses were used to identify predictors of knowledge of and perceived barriers to palliative care. A principal component analysis was carried out to identify the most appropriate factorial structure for the contents of knowledge and perceived barriers to palliative care. Three factors related to knowledge of palliative care were identified in both 2013 and 2018 data: ‘policy, regulation, and promotion’, ‘philosophy and treatments’, and ‘myths and misunderstandings’. Study findings for the two periods were similar. As for barriers to providing palliative care, three factors were identified for 2013: ‘quality care’, ‘difficulties’ and ‘communication’, and for 2018, ‘information’, ‘attitudes’ and ‘quality care’ were identified. Study findings differed between the two periods. Policies can better reinforce mitigating strategies—including opportunities for education, shared decision making, and changes in institutions and care systems. Additionally, assessing barriers creates important opportunities for further research to address the most critical aspects in improving end-of-life care for patients and their families.

Opportunities and constraints in the job search by public health graduates in their opinion

Strengthening of the professionalism of public health (PH) specialists may be the response to changes in health care systems. The aim of the study was to explore the potential and restrictions associated with job search by PH graduates, as well as to examine their opinions on their position on the labor market. The survey was conducted using questionnaire (CAWI) on 107 respondents from two medical universities in 2019. The average age of the respondents was 24.5. 5.61% and 17.76% of graduates from both universities respectively declared that the university prepared students well. Most respondents indicate internships, apprenticeships organized by employers (78%) and accepting graduates without professional experience (64%) as employers’ activities which facilitate entering the labor market. Graduates considered the most important obstacles in finding work to be: low interest in PH graduates work, insufficient contacts and relationships and insufficient professional experience. Their competencies do not coincide with the expectations of employers. Employers and universities do not establish sufficient cooperation. Although the dependency between the place of study and the graduates’ perception of the role of university and employers facilitating entry into the labor market and re-selection of the study is not strong, it should not be ignored in shaping education programs.

Emergency Department Utilization Among Maintenance Hemodialysis Patients: A Systematic Review

Rationale & ObjectiveTo evaluate predictors of emergency department (ED) utilization by adult patients receiving hemodialysis (HD) and interventions to reduce ED utilization by HD patients.Study DesignWe searched Ovid MEDLINE, Ovid Embase, and the Cochrane Library for randomized controlled trials and observational studies published until April 2020.Setting & ParticipantsWe included studies that investigated predictors of ED utilization and/or interventions to reduce ED utilization in HD patients. We extracted data regarding the study design and study population and results regarding ED utilization from 38 studies using Excel software.Analytical ApproachWe performed a narrative synthesis to group articles that investigated similar themes.Results1,060 titles and abstracts were screened, of which 98 were selected for full-text review. In total, 38 studies met the inclusion criteria and underwent data extraction. Quality was high according to the Downs and Black tool, with 11 studies rated as good, 22 as fair, and 5 as poor. 34 studies described predictors of ED utilization, whereas 4 studies investigated interventions in which ED utilization was studied. Our narrative synthesis produced 8 concept subgroups in the core concepts of access to care, comorbid condition burden, and new health care models. Poor access to care and a high comorbid condition burden are associated with increased ED use. No ED-based interventions designed to reduce ED utilization were identified, but recent changes in health care systems, like the formation of End-Stage Renal Disease Seamless Care Organizations and greater involvement of palliative care services, are associated with improved outcomes.LimitationsClinical heterogeneity and variability in the included studies precluded a meta-analysis.ConclusionsHD patients’ high ED use is multifactorial. Further research is required to understand and predict ED utilization in this vulnerable population, which will facilitate the development of interventions to reduce avoidable ED use.PROSPERO registration numberCRD42020196569

Trends in racial disparities of emergency department utilization for asthma in coronavirus disease 2019

Racial disparities between White and non-White patients with asthma in the United States have been documented before the coronavirus disease 2019 (COVID-19) pandemic.1,2 During the pandemic, non-White populations experienced disproportionately higher rates of COVID-19 infection, hospitalization, and mortality.3 Survey data of patients and providers also suggest that the pandemic worsened the ability of non-White patients with asthma’ to afford asthma medications and control their symptoms.4 The pandemic did, however, hasten the adoption of several societal and health care system changes, including mask use, social distancing, remote work and schooling, and expansion of telemedicine.

Association of Hospital Telestroke Adoption With Changes in Initial Hospital Presentation and Transfers Among Patients With Stroke and Transient Ischemic Attacks

It has been proposed that the implementation of telestroke services (a web-based approach to using video telecommunication to treat patients with stroke before hospital admission) changes where patients with stroke symptoms receive care, but this proposal has not been rigorously assessed. To assess whether the implementation of telestroke services is associated with changes in where and how patients initially present with stroke symptoms, in their decision to be transferred to another hospital, and which hospitals they are transferred to. This cross-sectional study compared changes in stroke systems of care between a sample of 593 US hospitals that adopted telestroke during the period from 2009 to 2016 but were not comprehensive stroke centers, major teaching hospitals, or thrombectomy-capable hospitals vs 593 matched control hospitals without telestroke based on rural location, critical access hospital status, bed size, primary stroke center status, presence of hospital alternatives in the community, hospital stroke volume, census region, and ownership. With the use of data on 100% of Medicare fee-for-service beneficiaries, all stroke and transient ischemic attack admissions from 2008 to 2018 were identified. For each hospital pair (telestroke plus matched control), the telestroke hospital's implementation date and difference-in-differences approach were used to quantify the association between telestroke implementation and changes in care from 2 years before implementation to 2 years after implementation. Models also controlled for differences in observed patient characteristics. Hospital stroke volume, patients' ambulance transport distance to initial hospital, hospital case mix, interhospital transfer proportion, and size of the receiving hospital for transferred patients. Of the 669 telestroke hospitals and 2143 potential control hospitals, 593 hospital pairs were matched; in each category, 261 hospitals (44.0%) were located in a rural area, 179 (30.2%) were primary stroke centers, and 130 (21.9%) were critical access hospitals. The changes in the preimplementation to postimplementation period were similar at telestroke and control hospitals in mean annual stroke volume (telestroke hospitals, decreased from 79.6 to 76.3 patients; control hospitals, decreased from 78.8 to 75.5 patients [-3.3 patients per year for both; difference-in-differences, 0.009; P ≥ .99]). Similarly, no differences were seen in ambulance transport distance, case mix, interhospital transfers, or bed size of receiving hospitals among transferred patients. This study suggests that, across a national sample of hospitals implementing telestroke, no association between telestroke adoption and changes in stroke systems of care were found.

78 COVID-19 Pandemic Did Not Exacerbate Racial Disparity in Incidence of Emergency Department Visits For Asthma Exacerbations

Racial disparities between White and minority (non-White) asthmatics in the United States have long been documented before the COVID-19 pandemic. During the COVID-19 pandemic, minorities were also found to disproportionately bear the burden of COVID-19-related severe outcomes. The pandemic hastened the adoption of several health care system and societal changes, including expansion of telemedicine via video or phone visits, mask usage, social distancing, and remote work and schooling. These could be seen as protective to asthmatics via decreased exposure to respiratory pathogens, and increased provider access.

Reducing inequality in avoidable emergency admissions: Case studies of local health care systems in England using a realist approach.

People in disadvantaged areas are more likely to have an avoidable emergency hospital admission. Socio-economic inequality in avoidable emergency hospital admissions is monitored in England. Our aim was to inform local health care purchasing and planning by identifying recent health care system changes (or other factors), as reported by local health system leaders, that might explain narrowing or widening trends. Case studies were undertaken in one pilot and at five geographically distinct local health care systems (Clinical Commissioning Groups, CCGs), identified as having consistently increasing or decreasing inequality. Local settings were explored through discussions with CCG officials and stakeholders to identify potential local determinants. Data were analysed using a realist evaluation approach to generate context-mechanism-outcome (CMO) configurations. Of the five geographically distinct CCGs, two had narrowing inequality, two widening, and one narrowing inequality, which widened during the project. None of the CCGs had designed a large-scale package of service changes with the explicit aim of reducing socio-economic inequality in avoidable emergency admissions, and local decision makers were unfamiliar with their own trends. Potential primary and community care determinants included: workforce, case finding and exclusion, proactive care co-ordination for patients with complex needs, and access and quality. Potential commissioning determinants included: data use and incentives, and targeting of services. Other potential determinants included changes in care home services, national A&E targets, and wider issues - such as public services financial constraints, residential gentrification, and health care expectations. We did not find any bespoke initiatives that explained the inequality trends. The trends were more likely due to an interplay of multiple health care and wider system factors. Local decision makers need greater awareness, understanding and support to interpret, use and act upon inequality indicators. They are unlikely to find simple, cheap interventions to reduce inequalities in avoidable emergency admissions. Rather, long-term multifaceted interventions are required that embed inequality considerations into mainstream decision making.

The PICASO cloud platform for improved holistic care in rheumatoid arthritis treatment\u2014experiences of patients and clinicians

BackgroundMultimorbidity raises the number of essential information needed for delivery of high-quality care in patients with chronic diseases like rheumatoid arthritis (RA). We evaluated an innovative ICT platform for integrated care which orchestrates data from various health care providers to optimize care management processes.MethodsThe Horizon2020-funded research project PICASO (picaso-project.eu) established an ICT platform that offers integration of care services across providers and supports patients’ management along the continuum of care, leaving the data with the owner. Strict conformity with ethical and legal legislations was augmented with a usability-driven engineering process, user requirements gathering from relevant stakeholders, and expert walkthroughs guided developments. Developments based on the HL7/FHIR standard granting interoperability. Platform’s applicability in clinical routine was an essential aim. Thus, we evaluated the platform according to an evaluation framework in an observational 6-month proof-of-concept study with RA patients affected by cardiovascular comorbidities using questionnaires, interviews, and platform data.ResultsThirty RA patients (80% female) participated, mean age 59 years, disease duration 13 years, average number of comorbidities 2.9. Home monitoring data demonstrated high platform adherence. Evaluations yielded predominantly positive feedback: The innovative dashboard-like design offering time-efficient data visualization, comprehension, and personalization was well accepted, i.e., patients rated the platform “overall” as 2.3 (1.1) (mean (SD), Likert scales 1–6) and clinicians recommended further platform use for 93% of their patients. They managed 86% of patients’ visits using the clinician dashboard. Dashboards were valued for a broader view of health status and patient-physician interactions. Platform use contributed to improved disease and comorbidity management (i.e., in 70% physicians reported usefulness to assess patients’ diseases and in 33% potential influence on treatment decisions; risk manager was used in 59%) and empowered patients (i.e., 48% set themselves new health-related goals, 92% stated easier patient-physician communications).ConclusionComprehensive aggregation of clinical data from distributed sources in a modern, GDPR-compliant cloud platform can improve physicians’ and patients’ knowledge of the disease status and comorbidities as well as patients’ management. It empowers patients to monitor and positively contribute to their disease management. Effects on patients’ outcome, behavior, and changes in the health care systems should be explored by implementing ICT-based platforms enriched by upcoming Artificial Intelligence features where possible.Trial registrationDRKS—German Clinical Trials Register, DRKS00013637, prospectively registered. 17 January 2018.

Health disparities experienced by Black Americans with multiple myeloma in the United States: A population-based study.

e18512 Background: Multiple Myeloma (MM) is the most common hematologic malignancy in Black Americans. Incidence and death rates for MM in Black Americans are more than double those in Whites. Our study aimed to evaluate trends of all cause in-hospital mortality among Black Americans with MM and to investigate characteristics of MM-related hospitalizations. Methods: We conducted a retrospective cross-sectional study of hospitalizations in adult patients with MM during 2008-2017 using the National Inpatient Sample (NIS), the largest all-payer inpatient care database in the US. We used joinpoint regression to assess temporal trends in the national incidence of in-hospital death. We conducted adjusted survey logistic regression to generate adjusted odds ratios to measure the likelihood of in-hospital death among MM related hospitalizations. Results: Admissions related to MM constituted 0.32% of all hospitalizations in the study period (913,967 out of 285,876,821). The prevalence of MM related hospitalizations was higher in Black Americans when compared with Whites (476.0 vs 305.6 per 100,000 hospitalizations, p &lt;0.01). In-hospital mortality with MM was higher in older patients, males, those belonging to lowest zip code quartile, and who self-paid for their treatment. Average Annual Percent Change (AAPC) showed a statistically significant decline of in-hospital mortality among all MM patients except Black Americans who had the highest inpatient mortality in 2016 and 2017. Black Americans received less autologous stem cell transplantation (ASCT) (2.8% vs. 3.8%, p &lt;0.01), more blood product transfusions (23.0% vs. 21.1%, p &lt;0.01), less palliative care consultation (4.0% vs. 4.6%, p &lt;0.01), less chemotherapy (10.8% vs. 11.2%, p &lt;0.01), and more intensive care utilization (5.3% vs. 4.3%, p &lt;0.01), when compared with Whites. Adjusted association between race/ethnicity and various outcomes confirmed observed differences [Table]. Conclusions: Black Americans with MM had the slowest improvement and highest inpatient mortality in recent years. Data suggests higher disease burden, more frequent hospitalizations, delay in accessing care and lower utilization of supportive care measures compared with White MM patients. Data highlight disparities in MM care for Black Americans necessitating a clarion call for urgent changes in health care systems.[Table: see text]

Support Strategies of Certified Nurses in Diabetes Nursing for Type 1 Diabetes Patients During Puberty/Adolescence

Study objective: To elucidate the support strategy of certified nurses who provide support for type 1 diabetes patients in puberty/adolescence. Study methods: We conducted focus group interviews with eight certified nurses who had at least one year of activity after certification and experience of providing support to type 1 diabetes patients in puberty/adolescence. The contents of the interviews were transcribed as data. We conducted qualitative and descriptive analysis with a focus on the context of conscious involvement, efforts, and thoughts toward patients being able to effectively manage their own condition. Results: The result of the analysis led to 12 subcategories which were grouped into five main categories as follows: << Adjusting the parent-child relationship associated with the care >>, << Linking the relationship with patients >>, << Being involved with the patient’s own perspective >>, << Identifying the management method that utilizes patients’ strength >>, and << Understanding and managing financial problems that develop from changes in the insurance system >>. Conclusions: As a strategy, certified nurses interacted with patients based on the developmental characteristics of puberty and adolescence, and adjusted relationships within the family in order to promote independence of the patient. In addition, certified nurses made efforts and provided support to prevent interruption of care management due to financial problems for patients at 20 years of age, when the medical care system changes.

Smoking Treatment: A Report Card on Progress and Challenges.

The impact of tobacco smoking treatment is determined by its reach into the smoking population and the effectiveness of its interventions. This review evaluates the reach and effectiveness of pharmacotherapy and psychosocial interventions for smoking. Historically, the reach of smoking treatment has been low, and therefore its impact has been limited, but new reach strategies such as digital interventions and health care system changes offer great promise. Pharmacotherapy tends to be more effective than psychosocial intervention when used clinically, and newer pharmacotherapy strategies hold great promise of further enhancing effectiveness. However, new approaches are needed to advance psychosocial interventions; progress has stagnated because research and dissemination efforts have focused too narrowly on skill training despite evidence that its core content may be inconsequential and the fact that its mechanisms are either unknown or inconsistent with supporting theory. Identifying effective psychosocial content and its mechanisms of action could greatly enhance the effectiveness of counseling, digital, and web interventions.