Responsive Care Research Articles

Evaluation of an intervention to improve Primary Health Care's response to cases of domestic violence against women - São Paulo, Brazil.

The aim was to analyse and improve the Primary Health Care (PHC) response to domestic violence against women (DVAW) by developing, implementing and evaluating an intervention. A pilot study evaluating the before and after of intervention implementation, using mixed methods and carried out in three phases - formative, intervention and evaluation - between August 2017 and March 2019 in two Basic Health Units (UBS) in the city of São Paulo. In this paper, we present the details and evaluation of the intervention, carried out six to twelve months after its implementation. The intervention was developed based on the findings of the formative phase and in line with the health policy that establishes the Violence Prevention Nucleus (NPV) and consisted of stablishing a care pathway; general training for all workers and specific training for the NPV; drawing up educational material and monthly case discussions over 6 months. The evaluation showed acceptability among the workers, increased identification and repertoire for caring for cases of DVAW, strengthening internal referral and the intersectoral network. We identified obstacles to the full implementation and sustainability of the intervention.

Access to general practice for preventive health care for people who experience severe mental illness in Sydney, Australia: a qualitative study.

People with lived experience of severe mental illness (PWLE) live around 20years less than the general population. Most deaths are due to preventable health conditions. Improved access to high-quality preventive health care could help reduce this health inequity. This study aimed to answer the question: What helps PWLE access preventive care from their GP to prevent long-term physical conditions? Qualitative interviews (n=10) and a focus group (n=10 participants) were conducted with PWLE who accessed a community mental health service and their carers (n=5). An asset-based framework was used to explore what helps participants access and engage with a GP. A conceptual framework of access to care guided data collection and analysis. Member checking was conducted with PWLE, service providers and other stakeholders. A lived experience researcher was involved in all stages of the study. PWLE and their carers identified multiple challenges to accessing high-quality preventive care, including the impacts of their mental illness, cognitive capacity, experiences of discrimination and low income. Some GPs facilitated access and communication. Key facilitators to access were support people and affordable preventive care. GPs can play an important role in facilitating access and communication with PWLE but need support to do so, particularly in the context of current demands in the Australian health system. Support workers, carers and mental health services are key assets in supporting PWLE and facilitating communication between PWLE and GPs. GP capacity building and system changes are needed to strengthen primary care's responsiveness to PWLE and ability to engage in collaborative/shared care.

Nurse Reports of Moral Distress During the COVID-19 Pandemic.

COVID-19 was devastating for many frontline nurses embroiled in health care's response. Most media outlets reported from several large metropolitan areas in New York, California, and Florida, leaving other regions to wonder about the extent to which their nurses were suffering. The purpose of this article was to understand the specific needs and experiences of Northeast Ohio nurses caring for patients with COVID-19 before designing interventions targeting negative mental outcomes. This phenomenological study interviewed 16 Northeast Ohio nurses to understand their experiences of caring for patients with COVID-19. Although not asked about it directly, the participants' stories consistently included details that could be linked to moral distress. Two themes describing their lived experiences included "acquiring moral distress" and "living with moral distress." Additional findings are also reported separately because although they do not represent the lived experience of COVID-19 nursing, they did represent significant concerns that participants had for the future and are reported here to assist other researchers with the intervention design. Furthermore, these participants thought that participation in support groups with other nurses who cared for COVID-19 patients and possibly led by mental health advanced practice nurses offered the best intervention to process their trauma from the pandemic. The long-term effects of moral distress have been discussed routinely in recent literature and are further complicated by the effects of the COVID-19 pandemic. Threats to the shrinking workforce of nurses must be taken seriously and interventions to improve the mental health and morale of frontline nurses must be prioritized and tested.

A descriptive analysis of the contents of Care Response, an international data set of patient-reported outcomes for chiropractic patients

BackgroundDatabases have become an important tool in understanding trends and correlations in health care by collecting demographic and clinical information. Analysis of data collected from large cohorts of patients can have the potential to generate insights into factors identifying treatments and the characteristics of subgroups of patients who respond to certain types of care. The Care Response (CR) database was designed to capture patient-reported outcome measures (PROMs) for chiropractic patients internationally. Although several papers have been published analysing some of the data, its contents have not yet been comprehensively documented. The primary aim of this study was to describe the information in the CR database. The secondary aim was to determine whether there was suitable information available to better understand subgroups of chiropractic patients and responsiveness to care. This would be achieved by enabling correlations among patient demographics, diagnoses, and therapeutic interventions with machine learning approaches.MethodsData in all available fields were requested with no date restriction. Data were collected on 12 April 2022. The output was manually scanned for scope and completeness. Tables were created with categories of information. Descriptive statistics were applied.ResultsThe CR database collects information from patients at the first clinical visit, 14, 30, and 90 days subsequently. There were 32,468 patient responses; 3210 patients completed all fields through the 90 day follow up period. 45% of respondents were male; 54% were female; the average age was 49. There was little demographic information, and no information on diagnoses or therapeutic interventions. We received StartBack, numerical pain scale, patient global impression of change, and Bournemouth questionnaire data, but no other PROMs.ConclusionsThe CR database is a large set of PROMs for chiropractic patients internationally. We found it unsuitable for machine learning analysis for our purposes; its utility is limited by a lack of demographic information, diagnoses, and therapeutic interventions. However, it can offer information about chiropractic care in general and patient satisfaction. It could form the basis for a useful clinical tool in the future, if reformed to be more accessible to researchers and expanded with more information collected.

Pandemic reflection: Significant change is needed to tap into the power of primary care during times of crisis.

Context: As a front-line resource, primary care could function as an indispensable health system resource during pandemic crises. However, throughout COVID-19, Canada's primary care providers expressed concern over their ability to respond. This study investigates factors related to these concerns, suggesting key areas for future primary care system development. Objective: Assess specific areas where robust, well-supported primary care could contribute significantly to the health system's pandemic response, & factors that may have prevented it from doing so. Study Design: Online, self-report survey administered over 3 weeks, April-May, 2021. Survey invitations sent via email, with three reminders following initial contact. Setting or Dataset: The College of Family Physicians of Canada (CFPC) membership list was used to reach family physicians in diverse practice settings in all Canadian provinces and territories. Population studied: All active CFPC family physician (FP) members were included. Most FPs in Canada are CFPC members; 39,991 FPs received survey invitations; 3,409 replied, for an overall response rate of 9%. Outcome Measures: Percent of FP engaged in systems level, pandemic response measures, including: 1) reporting COVID-19 cases to public health authorities, 2) identifying priority patients for vaccination, 3) participating in COVID-19 task forces, & 4) contributing to COVID-19 research/clinical studies. Results: Overall, one-third (34%) of FPs say that family practices in their region report COVID-19 cases to public health authorities. Most FPs (55%) say that their practices have not been asked to identify priority cases for COVID-19 vaccination. Less than 1-in-5 (19%) FPs have been involved in COVID-19 advisory/planning committees, task forces or groups. Very few FPs (6%) contribute to COVID-19 research/clinical studies. Half of FPs (50%) are highly concerned about the lack of clarity from government regarding FP response to the pandemic. These findings vary across jurisdictions and practice/remuneration models. Conclusions: Canada's primary care system has not been adequately engaged in important COVID-19 response measures, including monitoring viral spread in the population, pandemic planning, vaccination roll out, and therapeutic research. Practice models and remuneration arrangements are related to primary care's responsiveness to the COVID-19 pandemic,& should be considered in future primary care health system development.

Health care's response to climate change: a carbon footprint assessment of the NHS in England

SummaryBackgroundClimate change threatens to undermine the past 50 years of gains in public health. In response, the National Health Service (NHS) in England has been working since 2008 to quantify and reduce its carbon footprint. This Article presents the latest update to its greenhouse gas accounting, identifying interventions for mitigation efforts and describing an approach applicable to other health systems across the world.MethodsA hybrid model was used to quantify emissions within Scopes 1, 2, and 3 of the Greenhouse Gas Protocol, as well as patient and visitor travel emissions, from 1990 to 2019. This approach complements the broad coverage of top-down economic modelling with the high accuracy of bottom-up data wherever available. Available data were backcasted or forecasted to cover all years. To enable the identification of measures to reduce carbon emissions, results were disaggregated by organisation type.FindingsIn 2019, the health service's emissions totalled 25 megatonnes of carbon dioxide equivalent, a reduction of 26% since 1990, and a decrease of 64% in the emissions per inpatient finished admission episode. Of the 2019 footprint, 62% came from the supply chain, 24% from the direct delivery of care, 10% from staff commute and patient and visitor travel, and 4% from private health and care services commissioned by the NHS.InterpretationThis work represents the longest and most comprehensive accounting of national health-care emissions globally, and underscores the importance of incorporating bottom-up data to improve the accuracy of top-down modelling and enabling detailed monitoring of progress as health systems act to reduce emissions.FundingWellcome Trust.

Geocode Maps Spotlight Disparities in Telehealth Utilization During the COVID-19 Pandemic in New York City.

Geocode Maps Spotlight Disparities in Telehealth Utilization During the COVID-19 Pandemic in New York City.

Medicaid managed care enrollees report numerous problems in mandated support

A survey of Medicaid enrollees with serious mental illness (SMI) in a state with significant experience in integrating behavioral health and medical care is pointing out many shortcomings in managed care's response to these individuals' complex needs.

A systematic review of peer-reviewed literature authored by medical professionals regarding US biomedicine's role in responding to climate change.

Extant literature illustrates a substantive impact on human health because of climate change. Despite this, discussions of the ethical and policymaking role of US health care's response to this problem are underdeveloped within peer-reviewed literature indexed in core medical databases. We conducted a systematic literature review in August 2017 at Vanderbilt University Medical Center of the following medical, business and policy databases to examine the state of inquiry on this topic: PubMed, CINAHL, PsychINFO, JAMA Network, Health Affairs, Business Source Complete, Greylit.org, LexisNexis Academic, Proquest Dissertations and Theses Global. An initial sample of n = 4434 rendered n = 75 articles precisely addressing this question following a two-tiered systematic examination of content. US medical professionals were most concerned by the health impacts of air pollution and respiratory complications, extreme weather events, and rising infectious/vector-borne diseases. They were least concerned by rising rates of migration and stresses to sanitation systems. Medical professionals took a broadly proactive stance to the issue, highlighting the need to implement education and advocacy strategies. Politics was the least pertinent motivation for climate change-related recommendations. Furthermore, partnerships between health care and public agencies were identified as holding the greatest potential for meaningful change. Mitigation approaches were slightly more common than adaptation approaches. We conclude that, while the enthusiasm of the medical community is commendable, efforts to address climate change in US health care are overly fractured, and lack the necessary expertise for efficaciousness.

A web based PROM collection system for monitoring and service evaluation in musculoskeletal patients: Care Response

Background: Patient reported outcomes (PROMs) have been increasingly on the agenda of a number of European governments. In the UK these have been associated with postoperative collection of patient reported data since April 2009. The move towards centralizing the patient in the care process as well as quantifying outcomes important to the patient have led to calls for widespread use of these instruments by 3rd party payers. There are considerable barriers to implementing routine collection of data using traditional paper based methods. However, digital approaches hold promise in addressing such barriers. This paper will report the development of and results generated using a web based PROM/PREM collection system (CareResponse (CR)) specifically for use in MSK patients attending community based outpatient services. Methods: Care Response was developed as a tool to facilitate the routine collection of PROMs and other questionnaire based information directly from patients. The following components were identified as useful for supporting patients undergoing care and physicians in practice Reducing or removing the need for input from clinical organizations in requesting patients to complete follow up assessments. Maintaining flexibility for clinicians to ask patients to complete questionnaires when clinically indicated for example during a formal case review. Providing patients and clinicians instant access to their completed assessment forms Scoring PROM forms and presenting practitioners results in an easy to interpret graphical format suitable for discussion with patients Enabling clinicians to compare collated results from their patients with anonymized collated results from all users of the system. Thus providing benchmarking against which to judge their service. International Journal of Integrated Care – Volume 14, 01 November – URN:NBN:NL:UI:10-1-116543– http://www.ijic.org/ International Digital Health and Care Congress, The King’s Fund, London, September 10-12 2014. CR accomplishes these goals through the use of a cloud based relational database. Consenting patients are entered using their name, date of birth, and email address. In its routine use in clinical practice CR generates a ‘pre examination’ questionnaire containing questions preselected by the clinical organization. CR can send an email to the patients with a link to its database allowing patients to complete questions on any computing device able to access the internet. Alternatively patients may opt to complete the assessment either on paper (to be keyed in later by organizational staff) or more usually on a tablet while in the waiting area upon initial consultation. Follow up questionnaires can be generated automatically at timed intervals or specifically at time points according to clinical need. Results: At present 159 organisations delivering MSK care in the private sector are using this system. To date 25053 patient records have been collected. Conclusion: A web based approach to collecting PROMs and PREMs has generated large data sets in MSK patients that effectively describe service provision, patient outcomes and experiences. We believe this is a proven and innovative way to provide the data needed to monitor and assess the success and satisfaction of patients receiving health care provision in this and the wider health care sector.

Health Care's Response to Women Exposed to Partner Violence

Health Care's Response to Women Exposed to Partner Violence

Enhancement of attachment and cognitive development of young nursery‐reared chimpanzees in responsive versus standard care

Forty-six nursery-reared chimpanzee infants (22 females and 24 males) receiving either standard care (n = 29) or responsive care (n = 17) at the Great Ape Nursery at Yerkes participated in this study. Standard care (ST) consisted primarily of peer-rearing, with humans providing essential health-related care. Responsive care (RC) consisted of an additional 4 hr of interaction 5 days a week with human caregivers who were specially trained to enhance species-typical chimpanzee socio-emotional and communicative development. At 9 months, ST and RC chimpanzees were examined with the Bayley Scales for Infant Development to assess their Mental Development Index (MDI). At 12 months, the chimpanzees were assessed with their human caregivers in the Ainsworth Strange Situation Procedure (SSP). In this first study to use the SSP in chimpanzees, nursery-reared chimpanzees exhibited the definite patterns of distress, proximity seeking, and exploration that underpin the SSP for human infants. In ST chimpanzees the attachment classification distribution was similar to that of human infants raised in Greek or Romanian orphanages. RC chimpanzees showed less disorganized attachment to their human caregivers, had a more advanced cognitive development, and displayed less object attachment compared to ST chimpanzees. Responsive care stimulates chimpanzees' cognitive and emotional development, and is an important factor in ameliorating some of the adverse effects of institutional care.

Contract Management of Ontario's Cancer Surgery Wait Times Strategy

The province of Ontario, as a result of the First Ministers' Meeting, was committed to addressing surgery wait times in Ontario. The Ministry of Health and Long-Term Care's response to this commitment was the Wait Times Strategy (WTS) initiative, which addressed access issues with the aim of positively impacting wait times in cancer surgery. Cancer Care Ontario (CCO) was tasked with managing the cancer surgery WTS. CCO engaged in accountability agreements with Ontario hospitals to provide incremental cancer surgery volumes, in return for one-time funding. Through the use of accountability agreements, CCO was able to tie service volume delivery, quality care initiatives and reporting requirements to funding. Other elements of the cancer surgery WTS implementation included the development of wait times definitions, guidelines and targets; the use of a performance management system; facilitation by existing regional cancer leads and continued development of regional cancer programs. Eight key lessons were learned: (1) baseline volume guarantees are critical to ensuring that wait times are positively impacted; (2) there is a need to create a balance between accountability and systems management; (3) clinical quality initiatives can be tied to funding initiatives; (4) allocations of services should be informed by many factors; (5) regional leadership is key to ensuring that local needs are met; (6) data are invaluable in improving performance; (7) there is regional disparity in service delivery, capacity and resources across the province; and (8) program sustainability is an underlying goal of the WTS for cancer surgery. The implication is that accountability agreements can be leveraged to create sustainable health management systems.

Caregiver resentment: Explaining why care recipients exhibit problem behavior.

Caregivers of CI elders reported providing more care inresponse to CI-related care recipient disturbing behavior. However, beyond the source of impairment,disturbing (externally attributable) behavior typical of CI, and amount of care provided, resentment waspredicted by controlling and manipulative (internally attributable) care recipient behavior.

“Challenges and Strategies” and “Evidence-Based Care”

National experts discuss challenges and strategies for improving health care's response to domestic violence and moving toward evidence-based health care for domestic violence. Comments address ethical and legal issues, system incentives, public health and prevention, the need for evidence-based care, designing an effective research agenda, and outcome measurement.

Our first line of defense against bioterrorism Part 1

Health care's response to the anthrax outbreak highlights our critical need to enlist sophisticated information technology (IT) tools in the defense against bioterrorism. Part 1 of a two-part series explains what went wrong in the most recent attack and suggests how a national IT infrastructure might help in the future.

II. Special Report: Health Care Reform and Grantmakers: Survey Report

II. Special Report: Health Care Reform and Grantmakers: Survey Report