Continuity Of Care Research Articles (Page 1)

In countries without a gatekeeping system, including China, promoting primary healthcare (PHC) utilization can improve system efficiency and reduce healthcare burden. However, evidence on diabetes patients' PHC utilization and its impact on health outcomes remains limited. This study employs continuity of care (COC) to examine care-seeking behavior at PHC institutions in China and assess its association with clinical outcomes and healthcare costs. We conducted a retrospective cohort study in Yuhuan, Zhejiang Province, China, including 3,672 patients newly diagnosed with diabetes between 2016 and 2019. Data from chronic disease management records, follow-up service records, and electronic medical records from 2020 to 2023 were linked. COC was assessed from 2020 to 2022 using standard measures including the Continuity of Care Index (COCI), Usual Provider of Care (UPC), and Sequential Continuity (SECON), as well as PHC-specific measures: the Primary Healthcare Index (PHCI) and a binary indicator for having the primary healthcare institution as the usual provider of care (PHC-UPC). We evaluated clinical outcomes (hospitalization, glycemic control) and healthcare costs in 2023. Logistic and linear regression models were used to assess association, adjusting for patient demographics and clinical characteristics. The mean PHCI was 0.73. Higher PHCI was significantly associated with decreased outpatient costs (P < 0.001), decreased inpatient costs (P < 0.001), and a lower likelihood of hospitalization (OR = 0.503, P < 0.001). Similarly, having used a PHC-UPC was associated with reduced outpatient and inpatient costs (P < 0.001) and a lower likelihood of hospitalization (OR = 0.708, P < 0.001). However, among patients with poorly controlled diabetes, neither PHCI nor having used a PHC-UPC showed a positive association with glycemic control (OR = 0.496, P = 0.003; OR = 0.629, P = 0.002). Continuity at PHC significantly lowers hospitalization and healthcare costs in China's non-gatekeeping system. However, no significant improvement in glycemic control among poorly controlled diabetes was observed. Strengthening PHC capacity for personalized diabetes management and timely hospital referrals is essential to optimize outcomes.

Video consultations enable guideline-based and continuous medical care under the structurally challenging conditions of correctional facilities. This article presents the model of team-based telemedicine using concrete fields of application such as tele-general medicine, telepsychiatry, tele-substitution therapy, and teledermatology. Special attention is given to technical requirements, quality assurance measures, and the challenges and opportunities in correctional healthcare delivery. The approaches described are based on the experiences of the "Videoclinic" in more than 120 correctional institutions. In addition, the results of an initial empirical analysis of telemedicine routine care data (January 2023 to March 2025) and asatisfaction survey of medical and nursing staff (March 12 to 9 April 2024) are presented, which provide insights into the realities of healthcare delivery, the disease spectrum of inmates, and indications regarding the effectiveness and acceptance of telemedicine care in correctional settings.

BackgroundType 2 diabetes mellitus (T2DM) is a prevalent noncommunicable disease that is strongly associated with metabolic dysfunction-associated steatotic liver disease, a leading cause of cirrhosis and hepatocellular carcinoma. The Fibrosis-4 (FIB-4) index, a noninvasive tool for liver fibrosis assessment, is recommended for all patients with T2DM, yet its use in routine clinical practice remains unclear. We aimed to determine the prevalence of intermediate- and high-risk of advanced liver fibrosis using FIB-4 in patients with T2DM and to identify associated factors. We also assessed documentation of FIB-4 scores and referrals to gastroenterologists in primary care.MethodsWe conducted a cross-sectional study among patients with T2DM receiving continuous follow-up care in a primary care setting at a university hospital in southern Thailand during 2024. The FIB-4 index was calculated and categorized into low-, intermediate-, and high-risk groups. Binary logistic regression was used to identify factors associated with intermediate-to-high FIB-4 risk level.ResultsAmong 829 patients, 46.9% were classified as the intermediate-risk and 6.2% as the high-risk groups for having advanced fibrosis. A diabetes duration of ≥ 10 years was significantly associated with intermediate-to-high risk of advanced liver fibrosis [adjusted OR (95% CI) = 2.06 (1.51–2.81)]. Conversely, elevated triglyceride levels, low HDL cholesterol, and obesity were significantly associated with low risk of advanced liver fibrosis [adjusted OR (95% CI) = 0.65 (0.46–0.93), 0.68 (0.51–0.91) and 0.65 (0.49–0.88), respectively]. Imaging in the high-risk group revealed fatty liver in 61.1% and cirrhosis in 22.2%. However, FIB-4 scores were documented in only 1.6% of records, and only 4.1% of intermediate- to high-risk patients were referred to gastroenterology specialists.ConclusionMore than half of the patients with T2DM had a FIB-4 index suggesting increased risk of advanced liver fibrosis, especially those with longer disease duration. Despite this, FIB-4 remains underutilized in primary care, indicating missed opportunities for early detection and intervention.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12875-025-03039-x.

This study presents estimates of the prevalence, severity and correlates of mental health conditions in Australian emerging adults within geographic regions. We analysed data from 16- to 24-year-olds (N = 1620) of the 2020-2022 Australian National Study of Mental Health and Wellbeing, a national cross-sectional household survey. Estimated prevalence, population counts and unadjusted odds ratios of the 12-month Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) mental and substance use disorders (mental health conditions) are presented for Modified Monash Model categories (geographic region). Multivariable logistic regression models explored correlates of any mental health condition in the full sample, metro subgroup and regional, rural and remote subgroup. Over one-third of emerging adults met criteria for a mental health condition. Anxiety disorders were most prevalent (29.2%), then mood disorders (13.7%) and substance use disorders (7.8%). Prevalence was high across metro areas (36.1%); regional centres (35.4%); large rural towns (38.4%) and medium rural towns, small rural towns and remote communities (38.1%). Lifetime exposure to suicide or sexual assault was associated with mental health condition in all regions. In metro but not regional, rural and remote areas, female sex, neighbourhood disadvantage, household financial hardship, no engagement with education/employment, lifetime physical domestic or family violence, less social support and bodily pain were associated with mental health condition. Mental health conditions are prevalent among Australian emerging adults in metro, regional, rural and remote regions. Equitable solutions bringing together the full continuum of care in mental health, suicide prevention, sexual violence and bodily pain are needed to reduce their significant impact.

Background: Lipoprotein (a) [Lp(a)] is genetically inherited, causal and prevalent risk factor for Atherosclerotic Cardiovascular Disease (ASCVD). Despite a 10%−20% prevalence of elevated Lp(a), utilization of Lp(a) testing in clinical practice has been long felt to be poor. Elevated Lp(a), which is (≥50 mg/dL or ≥ 125 nmol/L), can increase the risk of heart attack, stroke, and peripheral artery disease. About 20-30% of people worldwide have high Lp(a), with the highest levels in Black/African American and South Asian populations. Methods: The American Heart Association’s Lp(a) FQHC Discovery Project applies implementation science to evaluate innovative quality improvement strategies, aiming to analyze Lp(a) testing trends and increase testing in Federally Qualified Health Centers (FQHCs) through data-driven initiatives. Baseline and monthly testing data was collected via Qualtrics to monitor progress and assess potential gaps in Lp(a) care continuums. Improvement efforts were discussed in monthly consults. Additionally, FQHCs shared knowledge and best practices during learning collaboratives. Results: A total of ten sites were enrolled, with participants submitting baseline data from June 2023 through May 2024. During the first three quarters of the intervention, sites averaged 407 tests ordered and 131 values recorded per quarter, a 13.6-fold and 5.2-fold increase, respectively, compared to baseline. One-third (n=308) of recorded Lp(a) values were high (≥50 mg/dL). Black/African American patients had the highest Lp(a) values. While 43% of patients were Black/African American, they accounted for 70% of Lp(a) values between 70–89 mg/dL and 61% of values ≥90 mg/dL. Conclusion: Findings showed that implementation science approaches can effectively enhance Lp(a) screening and awareness in FQHCs, resulting in increased testing. This project also highlights higher Lp(a) levels amid Black/African American patients, emphasizing the need for targeted education and risk management strategies. These results underscore the importance of sustained quality improvement, patient engagement and equity-focused approaches to ASCVD prevention.

This study evaluates the effectiveness of an innovative intelligent continuous care model delivered through a multi-platform digital network during the expansion phase of auricular reconstruction. The aim is to inform the development of future artificial intelligence-based care systems. In a zone-randomized design, patients were divided into experimental and control groups. The experimental group received continuous care through a multi-platform system that included WeChat management, educational manuals, instructional videos and electronic irrigation logs. Real-time monitoring and guidance for complications was also provided. Patient satisfaction and complication data were collected through a questionnaire platform. The experimental group demonstrated significantly improved knowledge comprehension and adherence (p<0.05), as well as higher treatment satisfaction and lower incidence of complications compared to the control group (p<0.05). The multi-platform intelligent continuous care model enhances patient experience and reduces the risk of complications, highlighting the transformative potential of modern communication technology in healthcare. The successful implementation offers valuable insights into the design of more efficient artificial intelligence care systems, signaling a shift toward the integration of technology into healthcare practice. This study provides moderate evidence supporting the effectiveness of a multi-platform intelligent continuous care model during the skin expansion phase of auricular reconstruction. The findings provide valuable insights for the design of future artificial intelligence care systems. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background Postpartum depression (PPD) is a prevalent mental health issue with significant implications for maternal and infant wellbeing. Despite extensive research, the complex interplay of perinatal factors contributing to PPD remains inadequately characterized. This study utilizes a network analysis approach to identify central depressive symptoms, critical perinatal risk factors, and pathways contributing to PPD among Chinese postpartum women. Methods A prospective observational study enrolled 377 women from 10 tertiary hospitals in China. Sociodemographic and perinatal factors were assessed shortly after childbirth. At 4–6 weeks postpartum, PPD symptoms were evaluated using the Edinburgh Postnatal Depression Scale (EPDS). Maternal and infant health outcomes, breastfeeding experiences, and family support were captured through self-administered questionnaires. Random forest and Bayesian network analyses were employed to identify influential factors and their interrelationships. Results Among the participants, 98 women (26.0, 95% CI: 21.6–30.7%) screened positive for PPD (EPDS score ≥10). Anxiety/Worry emerged as the most central symptom in the network, with the highest strength and centrality (Degree = 0.893, Betweenness = 0.888). Key risk factors included breastfeeding challenges (RF = 0.752), maternal physical complaints (RF = 0.431), and adverse infant health conditions (RF = 0.350). Protective effects were observed for prolonged skin-to-skin contact, family support for breastfeeding, and positive childbirth self-perception. Hospital type served as a central bridging node within the network, strongly connected with factors related to peripartum care services, childbirth experience and PPD. Conclusion This study reveals a significant prevalence of PPD among mothers in China. It underscores the positive impact of skin-to-skin contact, continuous postpartum care and tailored breastfeeding support in addressing PPD. These findings will advance PPD prevention strategies and inform evidence-based clinical practice in postpartum care.

Through a range of coping strategies, individuals seek to manage the stressors to which they are exposed, employing cognitive and behavioral responses that shape their emotional regulation of such events. Emergency first responders are routinely subjected to high-stress situations due to the nature of their duties and the continuous care of critically ill patients. This sustained exposure significantly increases their vulnerability to the development of mental health disorders, notably posttraumatic stress disorder (PTSD). The aim of this study was to determine the coping strategies used by first responders when facing critical incidents and their association with PTSD. A cross-sectional analytical study was conducted in 2022. All first responders from a volunteer fire department in a major Colombian city who voluntarily agreed to participate were included in the study. The participants were 28 ambulance crew members and 187 firefighters. Descriptive statistics were used for data analysis, and logistic regression models were applied to assess associations with PTSD. Principal components analysis was used to compute total scores, while the Lasso Method identified significant predictors. The first responders most often employed avoidance and denial as coping strategies in response to the demands of their work in the prehospital field. After witnessing devastating events, many of them turned to religion for stress relief. The study identified the use of maladaptive strategies associated with PTSD among staff, making it critical to develop training programs that help first responders cope with critical incidents by developing adaptive coping skills.

INTRODUCTION: The rapidly aging global population presents significant challenges, particularly in managing neurodegenerative diseases such as dementia. Addressing these challenges requires innovative solutions that ensure continuous care and monitoring of elderly individuals. Wearable technology offers a path to more inclusive and efficient care for older adults living with cognitive decline. OBJECTIVES: This paper presents the design, development, and refinement of an integrated wrist-worn wearable system to support the monitoring and care of elderly people living with dementia, expanding a previous proof of concept into a compact and energy-efficient prototype optimized for real-world usability. METHODS: The proposed system integrates advanced sensor technologies. It includes optical (MAX30101), inertial (BMI270), and GNSS (CAM-M10Q) sensors for monitor heart rate, blood oxygen levels, motion, and location. Data are transmitted via Bluetooth Low Energy (BLE) for indoor communication and LoRa for outdoor connectivity. A custom 4×4 cm PCB was designed to consolidate all components—microcontroller, sensors, power efficiency, communication modules, and display—into a single compact and robust layout. The design process also emphasized ergonomic comfort and usability through iterative prototyping and 3D modelling. RESULTS: The refined prototype significantly reduced the physical dimensions compared with the original proof of concept, while improving power efficiency, mechanical stability, and user comfort. The device layout and button interface were optimized to ensure intuitive interaction and safe daily use by elderly individuals. CONCLUSION: The developed prototype establishes the foundation for a fully functional, energy-efficient wearable system tailored to dementia monitoring. Future work will include firmware optimization, extended functional validation, and the integration of intelligent analytics for behaviour recognition and anomaly detection, aiming to provide caregivers with timely and actionable health insights.

Benefits of a comprehensive care model in patients with heart failure and atrial fibrillation: UMIPIC Program.

TORCH: addressing the gap in training for ward based care of major trauma patients.

Amputation versus limb salvage after gunshot wounds and combat injuries: Considerations for an integrative concept of surgical care and rehabilitation therapy.

With the rapid expansion of modern technologies and remarkable advancements in digital health, tele-nursing has emerged as one of the most innovative and significant care approaches in today’s world [1]. This modern method offers extensive opportunities to deliver continuous, cost-effective, and safe care to patients, bringing about profound transformations in healthcare systems [2]. Recent studies published on PubMed highlight that tele-nursing, particularly during situations such as the coronavirus disease 2019 (COVID-19) pandemic, played a critical role in reducing in-person interactions, preventing infection transmission, and safeguarding the health of both patients and medical personnel [3].

South Africa implemented the World Health Organization-recommended Targeted Universal Tuberculosis Testing (TUTT) among high-risk groups regardless of symptoms in 2021, a shift from the former symptom-based testing approach. We assessed the TUTT care cascade to describe its implementation within the care continuum. A descriptive retrospective analysis of routine TB/HIV program data from people with HIV (PWH) in high-burden districts-1 rural and 1 urban-was conducted for fiscal years (FY) 2022-2023. In total, 104,139 and 104,431 PWH presented to care in FY2022 and FY2023, respectively. In FY2022, 33.1% received an Xpert MTB/RIF Ultra (Xpert) test, 4.8% tested positive, and 96.3% started treatment. Likewise, in FY2023, the Xpert testing coverage was 32.3%, test positivity was 4.8%, and 95.6% started treatment. In FY2022, 46.5% of PWH in the rural district received an Xpert test, and 2.5% tested positive, whereas in the urban district, 20.3% received an Xpert test, and 9.7% tested positive. In FY2023, Xpert test coverage in the rural district declined slightly to 43.6%, with 2.7% testing positive, whereas in the urban district, Xpert tests increased slightly to 21.7%, with 8.9% testing positive. Tuberculosis treatment initiation was high in both rural (95.2% in FY2022 and 94.8% in FY2023) and urban districts (96.9% in FY2022 and 96.1% in FY2023). Low Xpert test coverage indicates inconsistent TUTT implementation, highlighting the need for better training, mentorship, and supervision. The differences between rural and urban districts reflect variations in epidemiology, health care infrastructure, and testing practices.

Switching antibiotic therapy from injectable to oral to optimise the duration of inpatient care for young infants presenting with moderate-mortality-risk signs of possible serious bacterial infection: an open-label, multicountry, randomised controlled trial.

An 8 yr old castrated male Cavalier King Charles spaniel dog was presented for an acute onset of an abnormal mentation and ataxia. After vomiting a large volume of material containing paintball shells, the diagnosis of paintball intoxication was made. Despite mild hypernatremia (157 mmol/L) that was unchanged from presentation, the dog developed tonic-clonic seizures 4 hr after admission. Approximately 11 hr after admission, the patient's plasma sodium increased to 170 mmol/L; the dog became comatose and required endotracheal intubation. Gastric lavage was performed to remove a conglomerate of residual paintball material. The dog's free water deficit was corrected to safely reduce plasma sodium to baseline levels over 12 hr. The patient remained comatose for 7 hr following correction of the acute hypernatremia and developed a Cushing reflex that responded to hyperosmolar therapy. With continued intensive care, his neurological status made gradual improvements and he was successfully discharged after 68 hr with a normal neurological examination. Two weeks after discharge, the owners reported that the patient was bright and alert, with no persistent clinical signs and normal blood parameters on recheck blood work. This case report highlights successful treatment of a dog that developed severe neurological signs following "nontoxic" paintball ingestion both before and after the development of acute hypernatremia.

Background: The midwifery-led continuum of care model is an approach where a single midwife or a team of midwives provides comprehensive care to a woman throughout pregnancy, childbirth, and the early postpartum period. This model of care has significantly improved maternal and newborn outcomes; however, it is primarily implemented in high-income countries. Objectives: To evaluate the effect of the midwifery-led continuum of care model on maternal and neonatal health outcomes in general hospitals of the Sidama region in Ethiopia. Methods: A prospective nonrandomized control trial was conducted from October 2023 to June 2024 in the Sidama region, Ethiopia. A systematic sampling technique was used to recruit 478 low-risk women in total for the intervention group and control group. Multivariable analysis for binary outcomes with the log link were conducted to estimate adjusted risk ratios Adjusted risk ratio (aRR) and 95% confidence intervals. Results: Women in the intervention were significantly more likely to have spontaneous vaginal birth (aRR) of 1.21 (95% confidence interval 1.14–1.67), and less likely to have preterm birth aRR of 0.16 (95% confidence interval 0.11–0.57) in comparison with women and newborns who received shared care. Conclusion: Women in the intervention group experience improved outcomes and seems to be a valuable strategy for improving pregnancy outcomes in low-resource settings. Further research should enhance the practical application of midwifery-led continuum of care for women facing social risk factors, and medical complications in low-resource settings. Trial registration: PACTR202310532830947 Website: https://pactr.samrc.ac.za/

Multilevel factors associated with timeliness of care along the lung cancer care continuum - A systematic review.

Background:Nonadherence jeopardizes treatment outcomes in the psychiatric care continuum. However, there was a paucity of data in the resource-limited life trajectories.Objectives:This study sought to uncover the psychotropic medications adherence behavior of older adults with severe mental disorders and its modeling predictors.Design:A hospital-based cross-sectional study was conducted in selected hospitals of the South Gondar Zone from March 1 to August 30, 2024.Methods:A multistage sampling technique followed by stratified and systematic random sampling methods was employed. Data were collected via interviewer-administered semistructured questionnaire and medical record review. A medication adherence rating scale, medication regimen complexity index instrument, Oslo social support scale, drug attitude inventory scale, and internal stigma monitoring index scale were utilized to assess adherence, treatment regimen complexity, social/family support, attitudes toward treatment, and internal stigma, respectively. Ordinal logistic regression deciphered key predictors using adjusted odds ratios (AORs) with a 95% confidence interval at p < 0.05.Results:The study sample comprised 423 patients with severe psychiatric disorder (mean (SD) age, 67.3 (±11.9) years; 56.03%, 237 male). Among the participants 255 (60.28%, (95% CI: 58.86–62.11)) had suboptimal adherence behavior. Age, education status, adherence counseling, attitude toward treatment, memory aids, internal stigma, insight, social support, illicit drug use, comorbidity, ADRs, patient-level medication regimen complexity index, and polypharmacy were the predictors identified in the final model.Conclusion:Despite multiple methodological limitations, this study suggests that suboptimal psychotropic medications adherence behavior was a critical challenge among older adults with severe mental disorders in geriatric mental healthcare in the Ethiopian hospital settings. We urge policymakers to devise evidence-based policies and strategies focusing on the identified predictors early on and intervene accordingly. Special attention should be given to individuals with low literacy levels, negative attitudes toward treatment, high internalized stigma, poor insight into their condition, substance use, comorbidities, adverse drug reactions, high levels of medication regimen complexity score, and those on polytherapy.

Stigma impedes the HIV care continuum and contributes to problematic mental health outcomes, nonadherence, and reduced quality of life. We prospectively analyzed changes in HIV stigma measures for 10 years among older people with HIV (PWH). PWH participating in the AGE h IV Cohort Study completed the full Berger HIV Stigma Scale (HSS) between 2012 and 2014 (T0) and 2 of the HSS subscales-that is, disclosure concerns and negative self-image (range per subscale: 3 to 12)-10 years later (T1) as part of routine clinical care. We assessed changes in scores over time using paired samples t-tests. We assessed sociodemographic and clinical factors associated with these changes at T1 using linear regression, and factors associated with higher or lower scores over time using linear mixed models. Disclosure concerns scores decreased significantly, albeit minimally, between T0 and T1; negative self-image scores remained stable. No factors were associated with changes in disclosure concerns scores. Higher disclosure scores were positively associated with living in households with 3 or more people. Women experienced significantly higher increases in negative self-image scores. Higher negative self-image scores were associated with being attracted to both men and women, compared with only men, and having moderate-to-severe depressive symptoms. Both HSS domains were negatively associated with more years since HIV diagnosis. In this cohort of predominately older, White, Dutch male PWH mostly with suppressed HIV, disclosure concerns and self-image did not improve over time. HIV stigma worsened in women and was worse for those in large households and with moderate-to-severe depression.