Doctors Plan Research Articles

Pattern of admissions and needs assessment for palliative care services among in-patients in a tertiary health facility in South-Western Nigeria

BackgroundPalliative care evolution focuses on education and medication accessibility. As little as 12% of palliative care needs are met. Assessment of the domains of Palliative care and patients’ and families’ experience are essential in life-limiting conditions. The Lagos University Teaching Hospital (LUTH), have the National Cancer Centre without offering palliative care services.AimThe aim was to examine pattern of admissions and needs assessment for palliative services among patients admitted into LUTH wards.Materials and methodResponses were entered into a data sheet inputted into Epi info version 7.2. Descriptive characteristics of the participants were presented as frequencies and percentages for age, sex, pattern of disease, domains of Palliative care, Advance care Plan, Preparation for home care, death and Education about the illness and category of medical conditions (palliative and non-palliative conditions). Together for Short Lives (TfSL) tool was used to categorize respondents’ conditions into Palliative and Non-palliative conditions. Chi-square test was used to determine association between independent variables (pattern of diagnoses, stage of disease, advanced care plan, preparation for home care/ death and education on illness) and dependent variables (category of medical condition). Chi-square test was also used to explore the association between specialty of the managing doctor (independent variable) and Advance care plan (dependent variable). The level of statistical significance was P-value < 0.05.Results80.6% of the respondents had palliative care conditions, 83.7% had family members as their caregiver while 13.2% of the participants had no caregiver and 65.9% had no advance care plan. There was no preparation for home care or death in 72.1%, 70.5% had education about their illness, and 68.2% were in the advanced stage of their disease. Participants attending the surgery non-trauma unit (51.6%) were more likely to have advance care plans. Adults were more likely to have palliative care conditions (79.8%) compared to children (20.2%), and was statistically significant.ConclusionMajority of the participants need palliative care services but are unavailable and unmet and the most predominant condition was cancer. Majority had no advance care plan or preparation for home care or death despite having advanced stage of the disease. This survey emphasized the need for symptom management, communication and provision of support.

DOCPRO DOCTOR APPLICATION

The rapid evolution of technology, has offered access to a variety of applications and technologies to healthcare professionals. This project addresses these challenges which provide information to the user about health issues, allowing a person to read, gather resources to make decisions, but also to introduce its own data. This project resolves to help doctors plan their appointments, out-patient &amp; in-patient care, handover of patients in case of leaves for seamless continuity of care. Keywords: Doctor, Appointments, in-patient, out-patient, healthcare

What does the doctor plan to say? Physician-generated plans for advance care planning conversations

Background: Importance of advance care planning or enabling individuals to make decisions regarding their future care is widely recognized. How physicians plan for or approach such conversations remains understudied. Aim: Physician plans were examined through a multiple goals theoretical framework. Of interest were the goals present within the plans as well as content referenced within each goal category. Method: In an online survey, physicians (n = 45) were provided a hypothetical scenario and asked to design a plan to communicate to the patient about their options for life-sustaining treatment. Providers were asked how they would engage in the conversation and what they would plan to discuss. A content analysis of physician responses was conducted. Results: Findings indicated that plans primarily consisted of task and identity goals. Content of reported plans overwhelmingly involved soliciting patient goals, explaining treatment options, and investigating patient knowledge of the medical condition. Conclusions: The current study addresses the paucity of research around what content providers prioritize and which conversational goals are present. This information affords role clarity for interdisciplinary teams and gives insight to where other team members can contribute to enhance patient outcomes. Reliance on theoretical frameworks offers a systematic build of this research where cross-study connections can be identified.

Prevalence, Reasons and Determinants of Patients' Nondisclosure to Their Doctors in Saudi Arabia: A Community-Based Study.

IntroductionPatient–doctor communication is a fundamental component of patients’ care. Withholding important information to the doctor can negatively affect the patients’ health and patient–doctor communication.AimThis study aimed to explore the fundamental types of information that patients hide from doctors, eg, the use of medication, health-related lifestyle, or disagreement with the doctor’s plan. In addition, this study examines the prevalence and reasons for this nondisclosure and factors associated with it.MethodologyAn online survey was conducted using a self-designed questionnaire, which was distributed to social media, targeting the residents of Saudi Arabia from February 1, 2021 to February 28, 2021. Respondents under 18 years of age and those who provided incomplete/incorrect data were excluded from the study. Types of nondisclosed information and their reasons were evaluated.ResultsA total of 2725 participants completed the questionnaire, and 1392 (51.1%) were males. About 43.2% of the participants were 18–29 years. Most (82%) responded “yes” to the question “Have you ever withheld any information from your doctor?” Nondisclosed information commonly involved disagreements with the recommendation (44.7%), not taking prescription medication as instructed (40.6%), and not understanding the instructions (37.4%). The most frequent reasons (68.7%) for nondisclosure were that the participants wanted to undergo further tests, did not like the doctor’s attitude (48.7%) and felt it did not matter to the doctor (43.2%). Those under 40 were more apt to withhold information (70.4%) than older participants (29.6%) p value = 0.0034. Other factors like gender, education level, and marital status were not associated with nondisclosure.ConclusionThe prevalence of nondisclosure to doctors is high. Effective communication skills and sound doctor–patient relationships may reduce this risk and improve the care delivered to the patients.

Correlates of Early Prenatal Care Access among U.S. Women: Data from the Pregnancy Risk Assessment Monitoring System (PRAMS).

ObjectivesEarly first trimester prenatal counseling could reduce adverse maternal and child health outcomes. Existing literature does not identify the length of time between suspecting pregnancy and attending their first prenatal visit. Identifying this potential window for change is critical for clinical practice, intervention programming and policy change.MethodsThe study sample was composed of women in the United States who responded to the Pregnancy Risk Assessment Monitoring Systems survey in 2016, for the following questions—when they first suspected pregnancy, when they attended their first prenatal visit, were they able to receive prenatal care as early as they wished, and perceived barriers to receiving prenatal care.ResultsOn average, participants became certain they were pregnant at 6.0 (SE = 0.1) weeks gestation, while participants reported having their first prenatal care visit at 9.3 (SE = 0.1) weeks, with clear health disparities by race, age, WIC participation, education level, and marital status. About 15% of women reported not receiving prenatal care as early as they wished. Structural or financial barriers in the health care system were common: 38.1% reported that no appointments available, 28.2% reported not having money or insurance to pay for the visit, 27.3% reported that the doctor or health plan would not start care, and 22.5% reported not having a Medicaid card.Conclusions for PracticeThis study illustrates a window for opportunity to provide earlier prenatal care, which would facilitate earlier implementation of prenatal counseling. Strategies to address barriers to care on the patient, provider and systemic levels, particularly among vulnerable population groups, are warranted.What is already known on this subject?Seeking prenatal care early is associated with better health outcomes for women and infants. A window of opportunity exists between suspecting pregnancy and attending a first prenatal visit.What this study adds?Clear health disparities were apparent in both recognizing their pregnancies, and receiving early prenatal care by race, age, WIC participation, education level, and marital status. About 15% of women reported not receiving prenatal care as early as they wished, and many attributed this later care to structural or financial barriers in the health care system.

Understanding quality and equity: patient experiences with care in older adults diagnosed with hematologic malignancies.

Oncology settings increasingly use patient experience data to evaluate clinical performance. Given that older patients with hematologic malignancies are a high-risk population, this study examined factors associated with patient-reported health care experiences during the first year of their cancer diagnosis. Cross-sectional study using the 2000-2015 SEER-CAHPS® data to examine patient experiences of Medicare enrollees with a primary diagnosis of leukemia or lymphoma. The primary outcomes were three CAHPS assessments: overall care, personal doctor, and health plan overall. We estimated case-mix adjusted and fully adjusted associations between factors (i.e., clinical and sociodemographic) and the CAHPS outcomes using bivariate statistical tests and multiple linear regression. The final sample included 1,151 patients, with 431 diagnosed with leukemia and 720 diagnosed with lymphoma (median time from diagnosis to survey 6months). Patients who completed the survey further apart from the diagnosis date reported significantly higher adjusted ratings of care overall (β .39, p = .008) than those closer to diagnosis. American Indian/Alaska Native, Asian, and Pacific Islander patients had lower adjusted ratings of care overall (β - .73, p = .003) than Non-Hispanic white patients. Multimorbidity was significantly associated with higher adjusted personal doctor ratings (β .26, p = .003). Unfavorable patient experiences among older adults diagnosed with hematologic malignancies warrant targeted efforts to measure and improve care quality. Future measurement of experiences of cancer care soon after diagnosis, coupled with careful sampling of high-priority populations, will inform oncology leaders and clinicians on strategies to improve care for high-risk, high-cost populations.

WITHDRAWN: Preliminary study of embedding two-level reinforcement learning to enhance the functionality of setting objectives compared with machine learning

The system designer needs to provide complete knowledge about the resources and ability, tasks and their particular implementation specifications in order to prepare the scenarios for tasks. For instance, hospitals need to follow stringent rules when planning doctors for COVID-19 patients so as to ensure that every patient receives adequate care while maintaining comfortable doctor planning. These concerns need to be profoundly learned, so that the impact of various mapping scenarios can be effectively analysed. An efficient asset mapping strategy task maximises the resource use under restrictions while reducing the time needed for a task which maximises the effectiveness of the task execution. A 2-stage strengthening training algorithm is proposed in this work for task planning. The algorithm uses a profoundly intensive learning phase to construct a deployable resource mapping strategy. Relevant execution breaks are reassessed and the plan is reassessed on the basis of the incremental learning from such break points. A real-time parametric testing of the resources and tasks is done in order to perform incremental learning and a new strategy is developed.

Beyond Pay‐for‐Performance: Can Different Feedback and Payment Distribution Methods Affect Team Performance?

Research ObjectiveThis study examines how, under team‐based pay‐for‐performance (P4P), managers incentivize physicians for teamwork through internal feedback and payment distribution methods. We evaluate whether these incentive methods affect team performance, drawing on theory of management and behavioral economics in interpreting why some feedback methods may be superior to others in specific contexts.Study DesignThe present research was conducted against the backdrop of Taiwan’s Family Doctor Plan (FDP), a program resembling US patient‐centered medical home initiatives in terms of team‐based care and value‐based purchasing. FDP created primary care teams, each consisting of 5‐10 physician practices, and rewarded the entire team if it achieved certain quality metrics. We developed an instrument and conducted a national survey of managers of 450 teams (response rate 46.9%). In the survey, managers assessed the extents to which their teams: (a) provided continuous, coordinated and comprehensive (3C) care, and (b) improved patient health as compared with the previous year. We then examined whether changes in performance scores could be materially explained by changes in feedback and payment distribution methods between and within groups. Because the choice of internal incentive methods may be correlated with unobserved, group‐specific factors such as team cohesion, we applied multilevel mixed‐effects linear regressions that accommodate endogenous time‐varying covariates. Furthermore, to tackle manager‐related bias, we included manager characteristics in the model and applied the Hausman‐Taylor approach to further accommodate endogenous time‐constant covariates.Population StudiedAfter deleting missing data, 138 primary care teams were included in the final study sample, forming a balanced panel with 276 group‐year observations.Principal FindingsAfter controlling for manager characteristics and other variables, all models tested showed that within teams, when physicians knew their own performances and anonymous peer performances, the team performed better than when physicians knew only their own performances, only team performances, or their own performances plus performances of named peers. Moreover, the results showed that varying methods for distributing performance pay had little effect on team performances.ConclusionsThe results suggest that nonfinancial incentives embedded in feedback are critical in improving team performance especially when financial incentives fail to motivate physicians. However, caution should be taken when applying principles of social comparisons, where public disclosure of identifiable peer performance may have a demotivating effect on lower‐rated physicians when they work in small teams and do not have full control over delivery of 3C care and patient outcomes. In this context, allowing physicians to compare their own performance with anonymous peer performance may be more effective as it appears to trigger low performers’ sense of competitiveness without making them less respected by team members.Implications for Policy or PracticeAdvocacy of P4P or feedback as quality improvement interventions does not typically seem to explicitly address their applications to team‐based models. This paper identifies a cost‐effective and easy‐to‐implement feedback method that is instrumental to health care managers and policy makers for improving team‐based care.Primary Funding SourceMinistry of Science and Technology.

Doctor Retention in Ireland - What It May Mean for the Global Health Workforce Reform Agenda Comment on "Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle".

The study of healthcare personnel migration in Ireland reports that most medical graduates plan to leave the country’s health system. It may be possible to address this challenge by understanding and addressing the reasons why young doctors plan to leave. Future studies should contribute to the retention of early career doctors in highincome countries such as Ireland. This will help reduce the migration of doctors from low- and middle-income countries in order to address the global health workforce crisis and its impact on the attainment of universal health coverage in all health systems.

Bedside Endorsement Of Patients (Beep): A Tool to Enhance Communication and Patient Involvement, a Critical Component of Patient Safety Culture

Introduction: Communication-related to care, treatment, and services with the patient and family serves as the vital characteristic of a culture of safety in the hospital setting. Reports have revealed a lack of communication or breakdown of communication to be the leading cause for 70% of all sentinel events. Kuwaitis represent only 6% of the countries nursing workforce, and only 30% of the doctors, most of the expatriate working force comes from non-Arab speaking countries. Standardizing shift changes and doing endorsements at the bedside is an attempt to reduce this communication gap among patients and their care providers. Methods: The current study thus attempts to assess the efficiency of Bedside Endorsement of Patients (BeEP) in promoting communication and patient involvement, both of which serve as critical components of patient safety culture. It is believed that once a high level of communication and patient involvement is established there will be a significant enhancement in patient satisfaction along with reduction in the patient and family anxiety. Result: The study results revealed BeEP implementation increases patient's awareness on multiple aspects related to their care such as knowledge of shift change timings, nurse name, dietary restrictions, medication course and time, doctors round timings, discharge date and plan of the day. Conclusion: An increase is thereby noted in terms of patient and family involvement in their care and timely response to patient’s inquiry resulting in increased satisfaction. Bedside endorsement of patients thus poses as the most suitable method to enhance communication as well as bridge communication gap between the nurses and the patients and to increase patient and family involvement.

Impact of integrated healthcare: Taiwan's Family Doctor Plan.

Integration of health services has been pursued worldwide. Diversity in integration approaches and in the contexts in which integrated programmes operate, however, hinders comparative analysis of care integration in both high-income countries (HICs) and low- and middle-income countries (LMICs). This study evaluates an HIC programme implemented in a delivery system resembling those of LMICs, especially its weak primary care system. The programme, Taiwan's Family Doctor Plan (FDP), targets high-cost and chronic patients, incorporating key elements of integrated care, viz., case management, multidisciplinary teams and care pathways. This study estimates the effects of shifting from usual to integrated care and locates contextual factors that may distort programme implementation. To estimate programme effects, difference-in-differences analysis is applied to a balanced panel comprising >160 000 patients over 2009-13. Because physician participation is voluntary, a propensity score matching method is used to match providers. The research findings reveal that introduction of the FDP has not reoriented the model of care from fragmented towards integrated health services. It reduces continuity of care and has no effect on co-ordination of care. Regarding quality of care, the FDP is shown to have no effect on avoidable admissions and increases drug injections and emergency department visits. Several contextual factors may serve as barriers that impede elements of FDP from generating desirable outcomes. These include absence of registration and gatekeeping systems; limited capacities of clinics; and preponderance of fee-for-service remuneration. These findings suggest that HIC design elements may not be directly transferrable to settings with weak primary care systems, as is typical of LMIC healthcare. Changes at the system level, such as establishing regular sources of care, may be necessary before elements of integrated care are introduced to a weaker primary care system.

The efficacy of using 3D printing models in the treatment of fractures: a randomised clinical trial

BackgroundThe aim of this study was to evaluate the efficacy of the use of three-dimensional (3D) printing models for preoperative planning in cases of complex fracture.MethodsIn total, 48 patients with AO type C fractures of the distal radius were enrolled in the study between January 2014 and January 2015. They were divided randomly into 3D model (n = 23) and routine treatment (n = 25) groups. A 3D digital model of each distal radius fracture in the former group was constructed. The model was exported to a 3D printer for construction of a full solid model. During each operation, the operative time, amount of blood loss, and frequency of intraoperative fluoroscopy were recorded, which were regarded as primary outcome measures. Patients were followed to evaluate surgical outcomes by Gartland–Werley scores, radiological evaluation, and range of motion of wrist, and these were regarded as the secondary outcome measures. In addition, we invited surgeons and patients to complete questionnaires.ResultsThe treatment of complex fractures using the 3D printing approach reduced the frequency of intraoperative fluoroscopy, blood loss volume, and operative time, but did not improve postoperative function compared with routine treatment. The patients wanted the doctor to use the 3D model to describe the condition and introduce the operative plan because it facilitated their understanding. The orthopaedic surgeons thought that the 3D model was useful for communication with patients, but were much less satisfied with its use in preoperative planning.ConclusionOur study revealed that 3D printing models effectively help the doctors plan and perform the operation and provide more effective communication between doctors and patients, but can not improve postoperative function compared with routine treatment.Trial RegistrationThis trial was registered at the Chinese Clinical Trial Registry on May 9, 2017 (ChiCTR-IRP-17011343, http://www.chictr.org.cn/showproj.aspx?proj=19264).

From Reception to Invention: The Arrival of Concrete to Iceland and the Rhetoric of Guðmundur Hannesson

The quick modernisation of Iceland, which took place rapidly from the first decades of the 20th century onwards, brought not only fishing trawlers and cars into the country. Among all the techniques of modernity, steinsteypa [concrete] was to become the key material that changed the built landscape of the island and was soon adopted by the first Icelandic architects, such as Rögnvaldur Ólafsson (1874–1914) and Guðjón Samúelsson (1887–1950). Interestingly, the main supporter of this material was Guðmundur Hannesson (1866–1946), a medical doctor and town planning enthusiast who wrote several articles and even a guidebook published in 1921, Steinsteypa. Leiðarvísir fyrir alþýðu og viðvaninga [Concrete: A Guidebook for Common People and Beginners]. In a country that was seeking an architectural self-representation, he understood the technical and formal possibilities that concrete could offer. By analysing his articles and publications, this essay aims to discuss the rhetoric of Guðmundur Hannesson and his role in writing an Icelandic chapter of the history of concrete, from its early stage of unmodern trial-and-error to the definition of a modern Icelandic architecture.

Are the odds shifting against pharma in the fight for cheaper treatment for macular degeneration?

Doctors plan to prescribe bevacizumab despite legal threats from drug companies, and against GMC and NICE guidance. Responses to the policy and new legal rulings hint at a turning point...

Colorectal cancer survivors’ surveillance patterns and experiences of care: A SEER-CAHPS study.

229 Background: Colorectal cancer (CRC) is the third most commonly diagnosed cancer, generally treated with surgical resection, followed by complex surveillance for recurrence. We examined associations between experiences of care and adherence to surveillance Medicare fee-for-service beneficiaries with a history of CRC. Methods: Using linked data from the National Cancer Institute Surveillance Epidemiology and End Results (SEER) cancer registry program, Medicare claims and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient experience surveys (SEER-CAHPS), we identified survivors ages 65+, diagnosed with local/regional first primary colorectal cancer 1999-2009 who underwent surgical resection and completed CAHPS survey within 36 months of diagnosis. Adherence to guidelines for a three-year observation period was defined as receiving a colonoscopy; at least 2 carcinoembryonic antigen (CEA) tests; and more than 2 office visits and 1 computer tomography (CT) imaging test each year. We dichotomized CAHPS ratings into 9 or 10 out of 10 versus 0-9 for analysis (higher ratings mean better quality). Results: Most of the 314 participants reported ratings of 9 or 10 for overall care (55%), personal doctor (59%), and health plan (60%). Slightly less than half (47%) gave their specialist doctor ratings of 9 or 10. Adherence to surveillance was 76% for office visits, 36.9% for CEA testing, 48.1% for colonoscopy, and 10.3% for CT Imaging. Sixty-two percent of the sample were categorized as adherent (receiving ≥ 2 surveillance guidelines). In multivariable models, adherence to office visits was positively associated with ratings of personal doctor (OR = 2.0; 95% CI = 1.1, 3.5) and specialist doctor (OR = 2.7; 95% CI = 1.4, 4.9), and overall adherence was associated with ratings of personal doctor (OR = 2.1; 95% CI = 1.2, 3.6). Conclusions: Findings point to the important role of patient-provider relationships in adherence to CRC post-resection surveillance guidelines. As adherence to surveillance may increase survival among CRC survivors, further investigation is needed to identify specific components of this relationship, as well as other potential modifiable drivers of surveillance guidelines.

Patients with challenging behaviors: Communication strategies

Some patients have behaviors that make interactions unpleasant, sometimes contributing to suboptimal outcomes and physician burnout. Understanding common difficult personality types can help doctors plan effective strategies for dealing with each, resulting in more effective communication, less stress, and better health outcomes.

Contribución de horas médicas del Plan de Médicos EDF a la Atención Primaria Municipa

Contribución de horas médicas del Plan de Médicos EDF a la Atención Primaria Municipa

Effect of the Implementation of the Family Physician Program 2015 on Fair Accessibility for People to Health Care Services in the Sistan Region

&lt;p&gt;Equitable access to primary health care is an indispensable right and a basic need of all human beings. Currently, the development of any society is judged based on the level of public access to primary health care services. This comparative study attempted to examine the fairness accessibility of people in Sistan to health care services through Family Physician Program 2015.&lt;/p&gt;&lt;p&gt;This was a descriptive, analytical research focusing on the level of equitable public access to primary health care in Sistan. Samples were taken from all the service-providing centers. Data were collected through HNIS software, network management center to analyze the gathered data. The results showed that prior to the implementation of the family doctor plan (before 2005), there was a doctor for every 9545 people, a midwife for every 10,000 people and one paramedic for 1,111 people. After beginning the family doctor plan, the figures showed that there was one doctor or MD for every 3387 people and one midwife for every 2916 people, and one health worker for every 549 rural residents. The implementation of the family physician program was an opportunity for the health system in Sistan region, where the appropriate resources management and equitable distribution of health care services throughout the region could facilitate accessibility to identical services.&lt;/p&gt;

Knowledge to advance planning decisions: The role of primary care medical staff

Objectives: Determine the knowledge, attitude and level of vital advance planning will medical staff in primary care, and identify associated factors. Material and method: Type of study: Cross-sectional study. Study population: Physicians of 15 Clinical Management Units at Cordoba Guadalquivir Health District (Cordoba). Sampling: whose simple random sampling (N) was used was 150. Tools: Questionnaire on knowledge, attitudes and planning. Analysis: Descriptive statistical analyses were done. Results: The average age was 51.3 years professionals (range 25-63; SD=8.36) 52.7% being women. 78.7% were owners and the average (years of service) was 21.6 (SD=8.87). 50.7% worked in urban areas. The average knowledge score was 4.9 (SD=2.11). 56.8% had not read the document living will and 81.5% had not read the planning guide. 63.3% did not locate the record living will. 88.2% do not plan in the past year living will and advance planning with the patient who makes less than 1 time. And beliefs (mean: 2.88; SD=3.6) values seem to influence the decision. Conclusions: Few doctors plan with the patient's life, not identified independent factors associated with the study.

Knowledge to advance planning decisions: The role of primary care medical staff

Objectives: Determine the knowledge, attitude and level of vital advance planning will medical staff in primary care, and identify associated factors. Material and method: Type of study: Cross-sectional study. Study population: Physicians of 15 Clinical Management Units at Cordoba Guadalquivir Health District (Cordoba). Sampling: whose simple random sampling (N) was used was 150. Tools: Questionnaire on knowledge, attitudes and planning. Analysis: Descriptive statistical analyses were done. Results: The average age was 51.3 years professionals (range 25-63; SD=8.36) 52.7% being women. 78.7% were owners and the average (years of service) was 21.6 (SD=8.87). 50.7% worked in urban areas. The average knowledge score was 4.9 (SD=2.11). 56.8% had not read the document living will and 81.5% had not read the planning guide. 63.3% did not locate the record living will. 88.2% do not plan in the past year living will and advance planning with the patient who makes less than 1 time. And beliefs (mean: 2.88; SD=3.6) values seem to influence the decision. Conclusions: Few doctors plan with the patient's life, not identified independent factors associated with the study.