Collaborative Healthcare Model Research Articles

Unscheduled home consultations by registered nurses may reduce acute clinic visits

BackgroundTo effectively utilize available healthcare resources, integrated care models are recommended. According to such model’s, registered nurses have the potential to increase patient access to health care services and alleviate organizational workload. Studies on acute home consultation assessments by registered nurses are sparse. The aim was to describe the reasons and actions for unscheduled same-day face-to-face registered nurse consultation at home offered to patients calling the national telephone helpline for healthcare in Sweden (SHD 1177), according to the integrated Collaborative Health Care model.MethodsA descriptive cross-sectional study was designed. Data from registered nurses (n = 259) working within the Collaborative Health Care model, who performed unscheduled consultations at home (n = 615) using a data collection tool from 2017 to 2018 were collected.ResultsAmong the 615 unscheduled home consultations performed by registered nurses, > 50% of the patients were managed at home as their health problems were not deemed as requiring a same-day referral to a clinic when assessed by the registered nurses. The most frequent health problems and reasons for contact were urinary tract problems, followed by medical and surgical conditions. Social factors, including living alone, impacted referral. Those living with a partner received care at home to a greater extent than those who lived alone.ConclusionAn integrated model for healthcare involving registered nurses direct assessment, action and accountability seems to be an efficient option for providing integrated care at home and reducing acute clinic visits.

Food Insecurity Is Associated with a Higher Risk of Mortality among Colorectal Cancer Survivors

Purpose: Food insecurity and colorectal cancer (CRC) are widely prevalent problems in the U.S. However, the long-term effects of food insecurity among people living with CRC are not well explored (e.g., risk of mortality). Methods: Data from the U.S. National Health and Nutrition Examination Survey (years 1999–2010) were linked with mortality data from the National Death Index up to 31 December 2019. Results: A total of 30,752 adults comprised the analytic sample; 222 were living with CRC and more than a tenth were food-insecure (11.6%). In our adjusted analysis, individuals who were food insecure and had CRC were 4.13 times more likely to die of any cause and 9.57 times more likely to die of cardiovascular diseases (compared to those without CRC and food insecurity). Conclusions: Colorectal cancer is among the top cancers diagnosed in American adults and more than a tenth of adult Americans with CRC live with food insecurity. Given the higher risk of mortality with co-occurring CRC and food insecurity, collaborative healthcare models can help address food insecurity and other social needs of people with CRC, and surveillance measures for food insecurity should be widely implemented across health systems.

Maternal Outreach Through Telehealth for Rural Sites: The MOTHeRS Project

The coronavirus pandemic brought challenges to rural maternal health. A patient-centered collaborative health care model using telehealth and health technologies was developed by professionals at ECU and implemented in Carteret, Duplin, Chowan, and Dare counties. Preliminary results show improvement in care access and reduced health disparities.

Depression in primary care and the role of evidence-based guidelines: cross-sectional data from primary care physicians in Germany

BackgroundDepression is the most common mental health burden worldwide. Primary care physicians (PCPs) play a key role in the care provision for people with depression. The first objective of the present study was to examine the health care situation of depression in primary care, focusing on the cooperation between PCPs and mental health specialists. Secondly, we aimed at examining the role of the German S3 Guideline for Unipolar Depression in the primary care provision.MethodsData of N = 75 PCPs were analysed from a cross-sectional online survey. Analysis of descriptive information on the current status of primary health care and depression was conducted. Further, to examine factors that are related to the usage of guidelines, multiple regression was performed.ResultsOnly 22.1% of PCPs described the quality of cooperation with ambulatory mental health specialist as good. The most frequent problems in the cooperation were of structural nature (49.3%, long waiting list, few therapy units, as well as barriers in the communication and the information exchange). With regard to the role of the guideline, 65% of PCPs reported never or seldom using the guideline and 31.7% of PCPs perceived the guideline as not useful at all. In addition, perceived usefulness of the S3 guideline was positively associated with the usage of the guideline. Results of the logistic regression revealed a significant association between the usage of the German S3 Guideline for Unipolar Depression and rating of perceived usefulness of the guideline (OR: 4.771; 95% CI: 2.15–10.59; p < 0.001).ConclusionThis study highlights the central role of PCPs and demonstrates major barriers in the outpatient health care provision of depression. Present findings suggest a strong need for collaborative health care models to resolve obstacles resulting from fragmented mental health care systems. Finally, reported perceived barriers in the implementation of the German S3 Guideline for Unipolar Depression indicate the urge to involve PCPs in the development of evidence-based guidelines, in order to ensure a successful implementation and usage of guidelines in clinical practice.

Collaborative Healthcare in Incarcerated Settings.

A total of 2,162,400 adults were incarcerated in the United States in 2016. Sub-optimal health status, existing healthcare disparities, and fragmented healthcare delivery among incarcerated populations are concerning and warrant redress. This article highlights the need for and discusses the benefits of collaboration between healthcare professionals in incarcerated settings. The roles of primary care health professionals, pharmacists, and medical family therapists (MedFTs) in correctional facilities are outlined. Through integrated healthcare models, enhanced communication, improved continuity of care, and holistic treatment plans, existing gaps in healthcare delivery in correctional facilities can be filled. By working together and assuming nontraditional roles, medical professionals can help improve health outcomes of incarcerated individuals. Collaborative healthcare models in incarcerated settings can elevate public health in a cost-effective, yet positive manner.

Implementing a person centred collaborative health care model – A qualitative study on patient experiences

BackgroundCollaborative Health Care (CHC) is a unique model in which ambulance services, home health care, hospital care and the national telephone helpline for healthcare in Sweden – Swedish health care direct (SHD1177) collaborate to provide the fastest possible health care for inhabitants living in eleven municipalities in western region of Sweden. AimTo explore how patients experience and perceive health care received in the CHC. MethodQualitative descriptive study using open-ended individual telephone interviews with fifteen community dwelling persons with experiences of care throughthe model CHC were conducted. ResultsTwo main categories and six subcategories were identified. The category “Thoughts of time in regard to acute health care” include “CHC leads to shorter waiting time for health care”, “Knowledge about the staff working hours” and “To alert or not alert”. The category “Thoughts on unplanned health care from CHC” involved “Receiving health care in my home”, ”Coordination from SHD1177 surprises” and “Accessibility of health care values higher than continuity”. ConclusionIntegrated health care models such as CHC are time saving and highly appreciated by community dwelling persons. The benefits of provision of coherent health care like in CHC, addresses the need to implement innovative integrated healthcare models in today’s health care.

Quality of rheumatology care for patients with fibromyalgia and chronic pain syndromes

BackgroundOne-third of primary care providers (PCPs) refer patients with fibromyalgia or chronic pain (FM/CP) to specialist care, typically rheumatology. Yet, comprehensive data on the quality of rheumatology care for patients...

Evaluation of a Pharmacy Service to Lower BMI Prior to Total Joint Arthroplasty

Background: Total joint arthroplasty (TJA) postsurgical complications are increased in patients with a body mass index (BMI) greater than 30 kg/m2. Reducing BMI prior to surgery can be complicated and it is important to find effective methods to achieve weight loss goals prior to surgery. Pharmacy services have proven to be effective models for weight loss in prior studies and may be an avenue for achieving BMI reduction prior to TJA surgeries. Objective: The purpose of this study was to examine the benefit of pharmacist-driven interventions in an ambulatory care setting to achieve weight loss goals prior to TJA orthopedic surgeries. Methods: A retrospective chart review was conducted on patients referred from an orthopedic surgeon’s office to a clinical pharmacist service providing chronic disease state management. Patients were referred based on need to decrease BMI prior to TJA orthopedic surgeries. Visits included evaluations of medications, education on weight loss management techniques, including therapeutic lifestyle changes, and recommendations for weight loss medications. Results: There was a statistically significant difference in post-BMI when compared with pre-BMI (P = .007). Of 16 subjects who had complete pre- and post-BMI measurements, 4 (25%) subjects met their BMI goal. There was a statistically significant relationship between the number of appointments and difference in BMI (ρ = −0.71, P = .002). Conclusion: Pharmacists may be utilized in a collaborative health care model in the ambulatory care setting to assist patients with lifestyle or medication management to achieve weight loss prior to orthopedic surgeries.

An integrated, collaborative healthcare model for the early diagnosis and management of dementia: Preliminary audit results from the first transdisciplinary service integrating family medicine and geriatric psychiatry services to the heart of patients\u2019 homes

BackgroundThe number of dementia cases is expected to rise exponentially over the years in many parts of the world. Collaborative healthcare partnerships are envisaged as a solution to this problem. Primary care physicians form the vanguard of early detection of dementia and influence clinical care that these patients receive. However, evidence suggests that they will benefit from closer support from specialist services in dementia care. An interdisciplinary, collaborative memory clinic was established in 2012 as a collaborative effort between a large family medicine based service and a specialist geriatric psychiatry service in Singapore. It is the first service in the world that integrates a family medicine based service with geriatric psychiatry expertise in conjunction with community-based partnerships in an effort to provide holistic, integrated care right into the heart of patients’ homes as well as training in dementia care for family medicine physicians. We describe our model of care and the preliminary findings of our audit on the results of this new model of care.MethodsThis was a retrospective audit done on the electronic medical records of all patients seen at the Memory Clinic in Choa Chu Kang Polyclinic from August 2013 to March 2016. The information collected included gender, referral source, patient trajectories, presence of behavioural and psychological symptoms of dementia and percentage of caregivers found to be in need of support. A detailed outline of the service workflow and processes were described.ResultsA majority (93.5%) of the patients had their memory problems managed at the memory clinic without escalation to other specialist services. 22.7% of patients presented with behavioural and psychological symptoms of dementia. When initially assessed, a majority (82.2%) of patients’ caregivers were found to be in need of support with 99.5% of such caregivers’ needs addressed with memory clinic services.ConclusionOur model of care has the potential to shape future dementia care in Singapore and other countries with a similar healthcare setting. Redesigning and evolving healthcare services to promote close collaboration between primary care practitioners and specialist services for dementia care can facilitate seamless delivery of care for the benefit of patients.

Mayo Clinic Care Network: A Collaborative Health Care Model

By leveraging its experience and expertise as a consultative clinical partner, the Mayo Clinic developed an innovative, scalable care model to accomplish several strategic goals: (1) create and sustain high-value relationships that benefit patients and providers, (2) foster relationships with like-minded partners to act as a strategy against the development of narrow health care networks, and (3) increase national and international brand awareness of Mayo Clinic. The result was the Mayo Clinic Care Network.

Medication Therapy Management and Collaborative Health Care: Implications for Social Work Practice

Medication therapy management (MTM) is a relatively new method of monitoring patient medication use and adherence. Medicare Part D has not only recognized its effectiveness and ability to enhance patient care, but has made MTM a required process for patient members with specific diseases (Doucette, McDonough, Klepser, & McCarthy, 2005). MTM provides a flamework for pharmacists and physicians to collaborate on medication administration and monitoring of medication use (Kuo, Bucldey, Fitzsimmons, & Steinbauer, 2004). Collaborative health-care models such as MTM offer promising possibilities for improved administration of services and enhanced quality of care for patients. These frameworks use the unique skills and knowledge of each specific health-care profession involved, and they offer opportunities for the field of social work. This article examines MTM within a framework of collaborative care. First, an overview of the collaborative model of health care is provided. Second, the use of MTM in monitoring medication adherence is examined. Third, the role of pharmacists in collaborative health care is evaluated. Finally, implications for the use of MTM in conjunction with services provided by the social work profession are addressed. COLLABORATIVE HEALTH CARE In the past several decades, health care has migrated from the historical use of the medical model toward a more integrative, collaborative approach. The medical model has been described as an individualistic, specific, and rational concept of health care (Engel, 1977; Weick, 1983). This approach treats the biological issues of the patient but does not address psychosocial needs (Bird & Rieker, 1999; Calnan & Johnson, 1985).This lack of attention to the person in environment does not allow health-care providers to address the impact of economic barriers to care (Hiatt et al., 2001), disruption of family homeostasis (Andrist, 1997), social and spiritual support systems (Doherty & McCubbin, 1985), and use of family and friends in the decision-making process (Webb & Koch, 1997). Collaborative care is emerging as an effective model of treatment (Gilbody, Bower, Fletcher, Richards, & Sutton, 2006), providing a framework in which to address the psychosocial needs of patients, improve health outcomes, reduce costs, and increase available resources and services to patients (Wagner, 2000). Collaborative care has been defined as a multidisciplinary team approach to delivering evidence-based care (Hedrick et al., 2003), one that provides an environment in which health-care professionals can teach one another and share resources (Sorrells-Jones & Weaver, 1999). The fields of medicine, pharmacy, social work, nursing, and pastoral care are key components to the success of collaborative teams (Cott, 1997). Research has supported the use of collaborative care in the treatment of mental disorders (Chang-Quan et al., 2009; Davies, McBride, & Sajatovic, 2008; Dewa, Hoch, Carmen, Guscott, & Anderson, 2009; Katon et al., 1999), heart disease (Brush et al., 2009; Coviello & Tadel, 2009), and diabetes (McElmurry et al., 2009; Phelps et al., 2009) and in the area of critical care (Carr, 2009). Collaborative care involving a working relationship between physicians and pharmacists has been shown to improve patient care and reduce medication errors (Kuo et al., 2004). A meta-analysis of 37 randomized studies of 12,355 patients diagnosed with depression reported that collaborative methods to improve medication adherence were more effective than standard care, improving both short- and long-term outcomes (Gilbody et al., 2006). The application of collaborative care in MTM is addressed in the next section. MEDICATION ADHERENCE AND MTM Medication Adherence To understand the impact of MTM, it is important to examine the issue of medication adherence. Medication behavior, the manner in which a patient adheres to prescribed medication use, strongly influences health outcomes, health-care use, improvements in medication knowledge, self-efficacy, and health-care costs (Chewning & Sleath, 1996; Delgado, 2000; Edworthy & Devins, 1999). …

The Future of Migraine: Beyond Just Another Pill

The Future of Migraine: Beyond Just Another Pill

Systemic Training for Healthcare Professionals: The Chicago Center for Family Health Approach

There has been increasing interest in family-centered, collaborative, biopsychosocial models of care by health and mental health professionals and consumers. This trend has led to growing demand and development of specialized training in family systems approaches to health care. This article describes the Families, Illness, and Collaborative Healthcare programs developed at the University of Chicago affiliate, the Chicago Center for Family Health. The program philosophy is guided by the following principles: a systems orientation focused on the family, a Family Systems Illness Model, a family resilience framework, a family-centered collaborative model of health care, and a social justice and advocacy orientation. Specific training components that implement these principles are described, including intensive certificate and fellowships; workshops, conferences, and institutes; and consultation and training services for community-based organizations. Discussion includes professional networking opportunities, funding challenges, and policy recommendations.

Overcoming the Hurdles to Providing Urban Health Care in the 21st Century

The delivery of health care services to urban populations in the United States is a system of rapidly increasing complexity. With the emergence of superspecialized physicians, a scientific approach to disease management has received great emphasis. Those providing health care at the population level may also apply this evidence-based approach. Analysis of the process of health care delivery in its entirety is complicated, confusing, and may be fraught with bias. In this article, a powerful instrument for providing a scientific approach to urban health care health policy development is introduced. This tool allows for analysis and assessment of hurdles to health care delivery to urban populations by dividing the process into elements of "administration," "provision," and "utilization" (APU). This APU triangle model, while intuitive, also allows a more definitive analysis by parts than would be possible to make of the whole. Using this model, the authors explore some of the hurdles faced by each element as well as some potential solutions. Although this model is presented in the context of urban hurdles to health care, it is equally applicable to rural environments or other service-delivery systems. In conclusion, this article discusses the emergence of the role of the public health department as the facilitator and manager between sectors of the community not traditionally connected in a collaborative health care model. Thus, the urban public health department coordinates efforts to surmount the hurdles and provides the venue for analysis, development, and employment of successful strategies.

Primary care pediatrics: 2004 and beyond.

Changes in medicine domestically and globally are transforming primary care in the United States. Many have suggested that primary care is in crisis or at least at a crossroads in the United States. The Annals of Internal Medicine recently devoted much of one issue to this topic.1 Primary care for children and adolescents, however, was not addressed specifically. This article focuses on pediatrics and identifies potential roles and new models for primary care pediatrics. The Institute of Medicine has defined primary care as “the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.”2 Starfield3 has defined 4 attributes of primary care including first-contact care, longitudinality, comprehensiveness, and coordination. September 11, 2001, the anthrax scare, and emerging threats such as severe acute respiratory syndrome (SARS) have brought a new focus on the importance of individual-level contacts in addressing population-level threats. Before these world events, however, primary care pediatrics was already grappling with its identity and responding to significant changes in medical systems, science, and family needs. The pace and scope of these changes are such that primary care pediatricians of the future will not be performing the same role as today. Historically, American medicine has tended to be reactive rather than proactive in defining its roles in society. However, dynamic change demands collective reflection; it is time to be proactive in assessing the needs of patients, exploring potential roles as health care providers, and developing the mechanisms to redefine the primary care pediatrician of the future. Projecting future trends requires reflection on the history of the profession of preventive pediatrics. In the 1800s, few physicians in the United States routinely … Address correspondence to Tina L. Cheng, MD, MPH, Johns Hopkins University Department of Pediatrics, 600 N Wolfe St, Park 392, Baltimore, MD 21287. E-mail: tcheng2{at}jhmi.edu

A collaborative health care model for the treatment of irritable bowel syndrome

Background & Aims : There have been few reports of successful treatment of chronically symptomatic patients with irritable bowel syndrome. We performed a preliminary single center study to evaluate a new collaborative treatment model that used both gastroenterologist and psychologist working together, compared to medical treatment or psychological treatment alone. A second goal was to determine the sample size that would be necessary to definitively demonstrate efficacy of such a collaborative treatment program. Methods : Forty-one patients with irritable bowel syndrome, seen in a tertiary setting, were randomly assigned to the 3 treatment groups. The research design was weighted toward collaborative treatment, which consisted of 3 biweekly visits. A series of questionnaires, including a 2-week daily diary as well as measures of quality of life, anxiety, depression, and relationships, were administered before treatment, after treatment, and again 3 months later. At termination of the study, patients completed a global assessment scale. Results : Sixteen patients completed the collaborative program, 8 completed medical treatment directed at gastrointestinal function, and 6 completed psychological therapy. Eleven patients dropped out of the study; 2 had organic disease. Intent to treat and per protocol analyses showed that global self-assessment improved significantly at long-term follow-up in the collaborative treatment group ( P < 0.0002). Abdominal pain, diarrhea, and constipation also improved significantly in the collaborative treatment group ( P < 0.001). Collaborative treatment was statistically superior to medical treatment alone ( P < 0.05). The psychological treatment group had 50% improvement in global score. There was no significant improvement in the medically treated group. Conclusions : We have demonstrated that short-term treatment with gastroenterologist and psychologist working together is more effective than medical treatment in relieving symptoms in patients with chronic irritable bowel syndrome. Attributes of a collaborative approach are discussed. These pilot data suggest that collaborative treatment programs should be explored in further studies, and they show the importance of dealing with both mind and body in these patients.

Opportunities and challenges in the deployment of global e-health

In developed countries, e-health has rapidly evolved from the delivery of online medical content toward the adaptation of generic e-commerce solutions to the processing of health-related administrative transactions and logistical support of clinical tasks. E-health is perceived as being particularly useful in the operational support of the new decentralised and collaborative healthcare models being implemented in many countries. Heretofore designed for large organisations and industrialised countries, e-health solutions are being increasingly proposed as an answer to the many health system management problems and healthcare demands faced by health organisations in developing societies. There are hard lessons to be learned from e-commerce, e-government, and e-health achievements and failures in developed countries and a careful examination of those experiences, vis-a-vis the characteristics of the health sector, organisational preparedness, and technological infrastructure of developing countries is a helpful exercise in the selection of appropriate e-health design and deployment strategies.

Visionary Medical and Other Leaders Meet to Plan Healthier Communities

Never doubt that a small group of thoughtful committed citizens can change the world. Indeed, it's the only thing that ever has. —Margaret Mead IT WAS A soaring vision of transforming the nation's health care system: creating healthier communities by empowering citizens, developing a new civic infrastructure at the grassroots level, harnessing systems thinking and high technology, and changing to a new collaborative model of health care. Optimism, enthusiasm, and idealism mixed with pragmatism prevailed at the fourth annual Healthier Communities Summit, sponsored by The Healthcare Forum, a San Francisco, Calif—based, action-oriented think tank. At session after session, speakers invoked the cando attitude reflected in anthropologist Margaret Mead's quoted remark. There was the hum of high energy in the air and the sound of music, from Afro-rock to American spirituals, as some 2500 representatives of the health care system, education, local government, business, and industry gathered for inspiration, ideas, and

A Collaborative Approach to Outpatient Care of Patients With HIV Infection

Patients with human immunodeficiency virus (HIV)-related disease have a host of related medical and other problems that respond to a collaborative model of health care. At the Infectious Disease Clinic at the Department of Veterans Affairs Medical Center, San Francisco, physicians and nurses provide collaborative outpatient health care for more than 500 HIV-infected patients in several specialty clinics.