Gaps In Continuity Of Care Research Articles

Childbirth Doula Training and the Experiences of Those Who Train as a Childbirth Doula

Objective:The objective of this article was to gain a deeper understanding and insight into the training and characteristics of childbirth doulas on the maternity care team. The aim was to integrate knowledge obtained from two studies: an integrative review (IR) of doula education programs globally (Study 1) and the qualitative experiences of those training to become a doula (Study 2).Methods:For the IR (Study 1), the modified Whittemore and Knafl (2005) framework and Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were used. Five electronic databases were searched (CINAHL, ProQuest Education Databases, ERIC, MEDLINE, and Scopus) usingdoulaandeducation/trainingas key terms. Nineteen papers were included in the review. For the qualitative study (Study 2), semi-structured interviews with 10 student doulas were analyzed using inductive thematic analysis.Results:The results highlighted ambiguity around the education (review) and scope of practice (qualitative) of a childbirth doula. The review showed a variety in duration, content, learning, certificate/accreditation, and educator qualifications in doula training programs, globally. The variety in student doulas’ understanding of their role in the maternity care context emerged from the key themes: (a) what influenced the decision to become a doula, (b) personal attributes perceived as essential to be a doula, and (c) what constitutes the role of a childbirth doula.Conclusions:This article highlights a variability in doula training legislation and accreditation, as well as program content and length. This variation may be reflected in student doulas’ understanding of their role in the maternity context. A better understanding of doula training and a defined scope of practice can fill the current gap in continuity of care and improve communication within the maternity care health team.

Lessons from the COVID-19 pandemic to strengthen NCD care and policy in humanitarian settings: a mixed methods study exploring humanitarian actors’ experiences

BackgroundThe COVID-19 pandemic and response severely impacted people living with non-communicable diseases (PLWNCDs) globally. It exacerbated pre-existing health inequalities, severely disrupted access to care, and worsened clinical outcomes for PLWNCDs, who were at higher risk of morbidity and mortality from the virus. The pandemic’s effects were likely magnified in humanitarian settings, where there were pre-existing gaps in continuity of care for non-communicable diseases (NCDs). We sought to explore factors affecting implementation of NCD care in crisis settings during the COVID-19 pandemic and the adaptations made to support implementation.MethodsGuided by the Consolidated Framework for Implementation Research, we undertook an online survey of 98 humanitarian actors from multiple regions and organization types (March-July 2021), followed by in-depth interviews with 13 purposively selected survey respondents (October-December 2021). Survey data were analysed using descriptive statistics, while interview data were analysed thematically, using both deductive and inductive approaches.ResultsInitially, humanitarian actors faced challenges influenced by external actors’ priorities, such as de-prioritisation of NCD care by governments, travel restrictions and supply chain interruptions. With each infection wave and lockdown, humanitarian actors were better able to adapt and maintain NCD services. The availability of COVID-19 vaccines was a positive turning point, especially for the risk management of people with NCDs and protection of health workers. Key findings include that, despite pre-existing challenges, humanitarian actors largely continued NCD services during the crisis. Enabling factors that supported continuity of NCD services included the ability to quickly pivot to remote means of communication with PLWNCDs, flexibility in medicine dispensing, and successful advocacy to prioritize NCD management within health systems. Key lessons learned included the importance of partnerships and cooperation with other health actors, and the mobilisation or repurposing of community health workers/volunteer networks.ConclusionsThe COVID-19 experience should prompt national and global health stakeholders to strengthen inclusion of NCDs in emergency preparedness, response, and resilience planning. Key lessons were learned around remote care provision, including adapting to NCD severity, integrating community health workers, providing context-adapted patient information, combating misinformation, and strengthening cross-sectoral partnerships.

The Chiraiya project: a retrospective analysis of breast cancer detection gaps addressed via mobile mammography in Jammu Province, India

BackgroundBreast cancer remains a pervasive threat to women worldwide, with increasing incidence rates necessitating effective screening strategies. Timely detection with mammography has emerged as the primary tool for mass screening. This retrospective study, which is part of the Chiraiya Project, aimed to evaluate breast lesion patients identified during opportunistic mammography screening camps in Jammu Province, India.MethodsA total of 1505 women aged 40 years and older were screened using a mobile mammographic unit over a five-year period, excluding 2020 and 2021 due to the COVID-19 pandemic. The inclusion criterion was women in the specified age group, while the exclusion criterion was women with open breast wounds, history of breast cancer or a history of breast surgery. The screening process involved comprehensive data collection using a detailed Proforma, followed by mammographic assessments conducted within strategically stationed mobile units. Radiological interpretations utilizing the BI-RADS system were performed, accompanied by meticulous documentation of patient demographics, habits, literacy, medical history, and breastfeeding practices. Participants were recruited through collaborations with NGOs, army camps, village panchayats, and urban cooperatives. Screening camps were scheduled periodically, with each camp accommodating 90 patients or fewer.ResultsAmong the 1505 patients, most were aged 45–50 years. The number of screenings increased yearly, peaking at 441 in 2022. The BI-RADS II was the most common finding (48.77%), indicating the presence of benign lesions, while the BI-RADS 0 (32.96%) required further evaluation. Higher-risk categories (BI-RADS III, IV, V) were less common, with BI-RADS V being the rarest. Follow-up adherence was highest in the BI-RADS III, IV, and V categories, with BI-RADS V achieving 100% follow-up. However, only 320 of 496 BI-RADS 0 patients were followed up, indicating a gap in continuity of care. The overall follow-up rate was 66.89%. Compared to urban areas, rural areas demonstrated greater screening uptake but lower follow-up rates, highlighting the need for tailored interventions to improve follow-up care access, especially in rural contexts.ConclusionThis study underscores the efficacy of a mobile mammographic unit in reaching marginalized populations. Adherence to screening protocols has emerged as a linchpin for early detection, improved prognosis, and holistic public health enhancement. Addressing misconceptions surrounding mammographic screenings, especially in rural settings, is crucial. These findings call for intensified efforts in advocacy and education to promote the benefits of breast cancer screening initiatives. Future interventions should prioritize improving access to follow-up care and addressing screening to enhance breast cancer management in Jammu Province.

Quality of primary health care for chronic diseases in low-resource settings: Evidence from a comprehensive study in rural China.

There is a paucity of evidence regarding the definition of the quality of primary health care (PHC) in China. This study aims to evaluate the PHC quality for chronic diseases in rural areas based on a modified conceptual framework tailored to the context of rural China. This comprehensive study, involving a patient survey, a provider survey and chart abstraction, and second-hand registered data, was set in three low-resource counties in rural China from 2021 to 2022. Rural patients with hypertension or type 2 diabetes, and health care workers providing care on hypertension or diabetes were involved. The modified PHC quality framework encompasses three core domains: a competent PHC system (comprehensiveness, accessibility, continuity, and coordination), effective clinical care (assessment, diagnosis, treatment, disease management, and provider competence), and positive user experience (information sharing, shared decision-making, respect for patient's preferences, and family-centeredness). Standardized PHC quality score was generated by arithmetic means or Rasch models of Item Response Theory. This study included 1355 patients, 333 health care providers and 2203 medical records. Ranging from 0 (the worst) to 1 (the best), the average quality score for the PHC system was 0.718, with 0.887 for comprehensiveness, 0.781 for accessibility, 0.489 for continuity, and 0.714 for coordination. For clinical care, average quality was 0.773 for disease assessment, 0.768 for diagnosis, 0.677 for treatment, 0.777 for disease management, and 0.314 for provider competence. The average quality for user experience was 0.727, with 0.933 for information sharing, 0.657 for shared decision-making, 0.936 for respect for patients' preferences, and 0.382 for family-centeredness. The differences in quality among population subgroups, although statistically significant, were small. The PHC quality in rural China has shown strengths and limitations. We identified large gaps in continuity of care, treatment, provider competence, family-centeredness, and shared decision-making. Policymakers should invest more effort in addressing these gaps to improve PHC quality.

SAT349 Participant Experiences of a Web-based Lifestyle Intervention for Postpartum Women With Recent Preeclampsia

Abstract Disclosure: C.E. Horn: None. J.M. Dias: None. G. Skurnik: None. A. Roche: None. J.J. Stuart: None. E. Tsigas: None. J.W. Rich-Edwards: None. E.W. Seely: None. Title Participant Experiences of a Web-based Lifestyle Intervention for Postpartum Women with Recent Preeclampsia. Introduction Patients with a history of preeclampsia have increased risk of developing cardiovascular disease (CVD) postpartum compared to their normotensive counterparts. The postpartum period following a preeclamptic pregnancy is a unique window of opportunity to implement lifestyle changes targeted at reducing future maternal CVD. Mobile, web-based health interventions can be leveraged to overcome many challenges of the postpartum period in this high-risk population. Here, we describe key findings of qualitative interviews conducted to gather feedback regarding a web-based lifestyle intervention to reduce cardiovascular risk in women with recent preeclampsia. Study Design A qualitative study was conducted with 21 women from the Heart Health for Moms (HH4M) study, a prospective, 9-month randomized controlled trial conducted nationwide to test the effectiveness of an online intervention to improve lifestyle for 151 women with recent preeclampsia (Clinical Trail Registration #NCT02147626). Within two months of completing HH4M, women were invited to participate in structured, phone-based interviews regarding their experiences in the study. Interviews were conducted until saturation was reached (n=21). Two investigators independently analyzed and coded interview transcripts for repeated concepts and themes. Results Four prominent themes emerged including: 1) the motivation for participating in research; 2) inadequate continuity of care postpartum and physician education regarding future risks; 3) importance of social support; and 4) the motivation provided by accountability. Overall, women chose to participate in the study to learn about preeclampsia risk and help themselves and others affected by preeclampsia. Many women were unaware of the link between preeclampsia and CVD prior to study participation and attributed this to inadequate clinical provider education or counseling as well as gaps in continuity of care from the pregnancy to the postpartum period. Participants reported positive impacts on their social support networks, including increased confidence to build community, the involvement of family and friends in healthy lifestyle behaviors, and a sense of connection to other participants. Women emphasized that interactions with the lifestyle coach made them feel accountable which was an important motivator. Conclusion HH4M provided accountability, motivation, and social support for women with recent preeclampsia to adopt healthy lifestyle habits in the postpartum period. Study participant feedback may inform the creation and dissemination of web or app-based interventions to educate, support, and empower women with recent preeclampsia. Presentation Date: Saturday, June 17, 2023

Pilot study of a text messaging-integrated and Chatbot-interfaced self-management program for symptom control in GI cancer patients undergoing chemotherapy.

e24117 Background: Chemotherapy treatments are increasingly provided in the outpatient setting. Patients are expected to monitor and manage a range of diverse and complicated side-effects without readily accessible clinical support. The overall goal of this study is to address the gap in continuity of care during outpatient chemotherapy through the integration of an innovative text messaging system with a Chatbot interface in the real-time monitoring and proactive management of side-effects among gastrointestinal (GI) cancer patients undergoing IV chemotherapy. Methods: Real-time chemotherapy-associated side effects monitoring supportive system (RT-CAMSS) was iteratively developed with patient-centered inputs and evidence-based and theory-guided information to address chemotherapy knowledge, self-care symptom management skills, emotional support, doctor-patient communication, and nutritional and physical activity suggestions. We conducted a single-arm 2-month pilot study, in which GI patients undergoing chemotherapy received two intervention text messages per week and a weekly CTCAE-based symptom assessment delivered through Chatbot interface with tailored feedback. Baseline and post-intervention patient-reported outcome follow-up surveys were collected. Results: 45 eligible patients were approached and 34 consented and enrolled (76% consenting rate). The mean age was 61 (±12). 56% were females and 61.8% were non-Hispanic White. The most frequent cancer type was pancreatic cancer (53%), followed by colon cancer (35%). 27 participants completed the post-intervention follow up (79% retention rate)..Functional wellbeing subscale of the FACT instrument showed significant improvement from baseline to 2 month ( p < 0.05). 27 participants responded to the weekly Chatbot-interfaced symptom assessment at least once (79% feasibility rate). The most frequent reported symptom collected from Chatbot assessment was constipation (50%), followed by weight loss (35%) and fatigue (32%). Post-intervention open-ended satisfaction survey found that participants perceived the intervention easy to use with helpful information. Conclusions: Communication via mobile technologies is highly scalable for improving health services. The study provides preliminary evidence of engagement, acceptability and benefits of RT-CAMSS, which should be evaluated in a controlled clinical trial.

\u201cMy first 48\xa0hours out\u201d: drug users\u2019 perspectives on challenges and strategies upon release from prison

BackgroundPrisoners report much higher prevalence rates of drug use and more harmful consumption patterns than the general population. People who use drugs have above-average experiences with the criminal justice system in general, and the prison system and subsequent release situations in particular. Release from prison is associated with increased mortality rates among drug users due to the risk of overdose. The EU-funded project ‘My first 48 hours out’ aimed to address the gaps in continuity of care for long-term drug users in prison and upon release, with a special focus on drug user’s perspectives on needs and challenges upon release.MethodsA multi-country (Belgium, France, Germany and Portugal) qualitative study was set up to explore drug users’ perceptions of drug use and risk behaviour upon prison release, experiences of incarceration and release, and strategies to avoid risks when being released. In total, 104 prisoners and recently released persons with a history of drug use participated in semi-structured interviews and focus groups discussions on these topics.ResultsRespondents pointed out that there are numerous challenges for people who use drugs when released from prison. Lack of stable housing and employment support were frequently mentioned, as well as complex administrative procedures regarding access to services, health insurance and welfare benefits. Besides structural challenges, individual issues may challenge social reintegration like ‘old habits’, mental health problems and disrupted social networks. As a result, (ex-)prisoners adopt individual strategies to cope with the risks and challenges at release.ConclusionMeasures to prepare prisoners for release often do not focus on the individual and specific challenges of persons who use drugs. Psychosocial and medical support need to be improved and adjusted to drug users’ needs inside and outside prison. To improve the quality and continuity of care around release, the perspectives and coping strategies of people who use drugs should be used to better address their needs and barriers to treatment.

Parents' perceptions of the transition of their child who is ventilator dependent from hospital to home.

The number of children who are ventilator dependent and being cared for at home by their families has risen dramatically in recent years. Parents' roles are often taken for granted, with little recognition of the effect of the shift from parent to carer on families. The aim of this literature review was to explore parents' perceptions of the burden of care placed on them during the transition of their child who depends on a ventilator from hospital to home, the support they received during discharge and any gaps in continuity of care. An electronic database search was undertaken of PubMed, Cumulative Index to Nursing and Allied Health Literature and PsycINFO. After exclusion a total of 14 studies were reviewed and critiqued. The main themes identified were: transition: preparing for discharge; feelings of isolation on transitioning home; and the strive for normality or a sense of control felt by parents and family members. Where facilitated, families are more than capable of providing skilled, competent care at home to a child who is ventilator dependent. The long-term effects of this arrangement are largely unknown so far, but the literature shows that it has a substantial psychosocial effect on families. More information and education for healthcare professionals is required about the experiences of these families to appreciate the struggles they face after discharge. This may have a positive effect on how nurses and other professionals support parents during the discharge process.

Addition of Advanced Practice Registered Nurses to the Trauma Team: An Integrative Systematic Review of Literature.

The total cost of inpatient care from a traumatic mechanism of injury in the United States between 2001 and 2011 was $240.7 billion. Medical resident work hour reductions mandated in 2011 left a shortage of available in-hospital providers to care for trauma patients. This created gaps in continuity of care, which can lead to costly increased lengths of stay (LOS) and increased medical errors. Adding advanced practice nurses (APNs) specializing in acute or trauma care to the trauma team may help fill this shortage in trauma care providers. The purpose of this integrative systematic review of the literature was to determine whether adding APNs to the admitting trauma team would decrease LOS. A systematic review of primary research in CINAHL and PubMed databases was performed using the following terms: nurse practitioner, advanced practice nurse, trauma team, and length of stay. Included studies examined the effects of adding APNs to trauma teams, were written in English, and were published in 2007-2017. Six studies were included in the final sample, and all were completed at Level I trauma centers in the United States except one from Canada. Combined sample size was 25,083 admitted trauma patients. All 6 studies reported a decrease in LOS ranging from 0.8 to 2.54 days when APNs were added to the trauma team. More research is needed to identify the best utilization of an APN on a trauma team. It is recommended that all trauma centers add APNs to the trauma team to not only decrease admitted trauma patients' LOS but also provide continuity of care, decreasing costs, and minimizing errors.

The HIV care continuum among resident and non-resident populations found in venues in East Africa cross-border areas.

IntroductionHIV care and treatment in cross‐border areas in East Africa face challenges perhaps not seen to the same extent in other geographic areas, particularly for mobile and migrant populations. Here, we estimate the proportion of people with HIV found in these cross‐border areas in each stage of the HIV care and treatment cascade, including the proportion who knows their status, the proportion on treatment and the proportion virally suppressed.MethodsParticipants (n = 11,410) working or socializing in public places in selected East Africa cross border areas were recruited between June 2016 and February 2017 using the Priorities for Local AIDS Control Efforts method and administered a behavioural survey and rapid HIV test. This approach was designed to recruit a stratified random sample of people found in public spaces or venues in each cross border area. For participants testing positive for HIV, viral load was measured from dried blood spots. The proportion in each step of the cascade was estimated using inverse probability weights to account for the sampling design and informative HIV test refusals. Estimates are reported separately for residents of the cross border areas and non‐residents found in those areas.ResultsOverall, 43% of participants with HIV found in cross‐border areas knew their status, 87% of those participants were on antiretroviral therapy (ART), and 80% of participants on ART were virally suppressed. About 20% of people with HIV found in cross border areas were sampled outside their subdistrict or subcounty of residence. While both resident and non‐resident individuals who knew their status were likely to be on ART (85% and 96% respectively), people on ART recruited outside their area of residence were less likely to be suppressed (64% suppressed; 95% CI: 43, 81) compared to residents (84% suppressed; 95% CI: 75, 93).ConclusionsPeople living in or travelling through cross‐border areas may face barriers in learning their HIV status. Moreover, while non‐residents were more likely to be on treatment than residents, they were less likely to be suppressed, suggesting gaps in continuity of care for people in East Africa travelling outside their area of residence despite timely initiation of treatment.

An Attempt to Eradicate Alcohol Dependency from Adult Men in Service Privately Managed Pharmaceutical Institutions in India

An Attempt to Eradicate Alcohol Dependency from Adult Men in Service Privately Managed Pharmaceutical Institutions in India

How to Implement Transitional Care in France: first lesson

Introduction: Gaps in continuity of care may happen at hospital discharge, especially in elderly patients. Patients arriving at home have difficulty to manage themselves the care that was driven by the hospital team. It is well known that transitional care interventions can reduce hospital readmissions. Though, they are poorly developed in France.Objectives: Our project was to tailor and implement transitional care in an Acute Geriatric Department of a French University Hospital. Our approach is based on patient and/or caregiver empowerment to allow self-managed care. This pilot study evaluated the interest of a coaching intervention.Method: A transitional care manager met patients returning home, for a 20 minutes semi-structured interview. He asked about information they have and remaining questions, encouraging them to ask the hospital team. A follow-up phone call was made 3 weeks after.We report here quantitative data obtained in the interviews and qualitative analysis of the implementation of this procedure.Results: We included 250 patients in 2 years (mean age 84), who represent half of home discharge. The semi-structured interviews show that only 40% of the patients knew the changes made in their usual medication, and one third knew that they have to contact their general practitioner. At follow-up calls, 23% reported a change in medications after discharge, 29% needed advices, 38% have not seen their general practitioner yet.We elaborate an information form to support medical discharge meeting, and propose after one year a mandatory training for junior medical staff on transitional care; these interventions did not change the results.Implementations barriers will be discussed.Conclusion: A coaching approach is not sufficient in the context of a French University hospital, as patients don’t currently get enough information to allow empowerment. A more global person centered care approach with nurse care managers promoting patient activation via teamwork is currently designed.

Emergency Department Visits Following Elective Total Hip and Knee Replacement Surgery: Identifying Gaps in Continuity of Care.

Major joint replacement surgical procedures are common, elective procedures with a care episode that includes both inpatient readmissions and postoperative emergency department (ED) visits. Inpatient readmissions are well studied; however, to our knowledge, little is known about ED visits following these procedures. We sought to characterize 30-day ED visits following a major joint replacement surgical procedure. We used administrative records from California, Florida, and New York, from 2010 through 2012, to identify adults undergoing total knee and hip arthroplasty. Factors associated with increased risk of an ED visit were estimated using hierarchical regression models controlling for patient variables with a fixed hospital effect. The main outcome was an ED visit within 30 days of discharge. Among the 152,783 patients who underwent major joint replacement, 5,229 (3.42%) returned to the inpatient setting and 8,883 (5.81%) presented to the ED for care within 30 days. Among ED visits, 17.94% had a primary diagnosis of pain and 25.75% had both a primary and/or a secondary diagnosis of pain. Patients presenting to the ED for subsequent care had more comorbidities and were more frequently non-white with public insurance relative to those not returning to the ED (p < 0.001). There was a significantly increased risk (p < 0.05) of isolated ED visits with regard to type of insurance when patients with Medicaid (odds ratio [OR], 2.28 [95% confidence interval (CI), 2.04 to 2.55]) and those with Medicare (OR, 1.38 [95% CI, 1.29 to 1.47]) were compared with patients with private insurance and with regard to race when black patients (OR, 1.38 [95% CI, 1.25 to 1.53]) and Hispanic patients (OR, 1.12 [95% CI, 1.03 to 1.22]) were compared with white patients. These increases in risk were stronger for isolated ED visits for patients with a pain diagnosis. ED visits following an elective major joint replacement surgical procedure were numerous and most commonly for pain-related diagnoses. Medicaid patients had almost double the risk of an ED or pain-related ED visit following a surgical procedure. The future of U.S. health-care insurance coverage expansions are uncertain; however, there are ongoing attempts to improve quality across the continuum of care. It is therefore essential to ensure that all patients, particularly vulnerable populations, receive appropriate postoperative care, including pain management. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Visits to the Emergency Department After Joint Replacement: Commentary on an article by Micaela A. Finnegan, BA, et al.: "Emergency Department Visits Following Elective Total Hip and Knee Replacement Surgery: Identifying Gaps in Continuity of Care".

Visits to the Emergency Department After Joint Replacement: Commentary on an article by Micaela A. Finnegan, BA, et al.: "Emergency Department Visits Following Elective Total Hip and Knee Replacement Surgery: Identifying Gaps in Continuity of Care".

Physician and Patient Survey of Taper Schedule and Family Physician Letters Following Discharged from the Acute Pain Service.

Following discharge, patients requiring high opioid doses may be at risk for both under- and overdosing, posing a major challenge to community physicians. The aim of this study was to examine the effectiveness and degree of satisfaction with a personalized taper schedule and physician letter through interviews of patients and physicians. This was a 1-year prospective study. Following ethics approval and informed written consent, patients admitted for elective surgery, 18 to 60 years of age, receiving opioid analgesics, were recruited. Prior to discharge, the acute pain service team provided patients with a taper schedule explained in detail. Individualized physician letters were faxed to treating family physicians. Patients were contacted by phone 2, 4, and 6 weeks after discharge. Physicians were contacted once, a month after discharge. Patients and physicians were asked to grade the taper schedule on a 1- to 5-point Likert scale. Questions pertained to clarity, usefulness, ability to follow the instructions, and general satisfaction. Twenty-six patients and 21 physicians completed the study. Physicians were generally satisfied with both the taper schedule and letter and rated all aspects between 3.76 and 4.38 of 5. Similarly, patients were satisfied with the taper schedule and rated all aspects between 4.08 and 4.5. Both physicians and patients generally found the taper schedule and letter helpful in assisting them to taper off their opioid use. This is one way of bridging the gap in continuity of care between the acute and primary care providers while reducing the risk to patients during the transition period.

Gaps in continuity of care: patients' perceptions of the quality of care during labor ward handover in Mulago hospital, Uganda.

BackgroundClient satisfaction is a common outcome measure for quality of care and goal for quality improvement in healthcare. We assessed women’s perceptions of the structure, process and outcome of intrapartum care in Mulago hospital, specifically, labor ward duty shift handovers.MethodsData was collected through 40 in-depth interviews conducted on two occasions: during the time of hospitalization and within 4–6 months after childbirth. Participants were women who delivered at the hospital, of whom some had life-threatening obstetric complications. Data was analyzed by thematic analysis.ResultsMaternity duty handovers were associated with patient dissatisfaction, particularly the process of hand-over, the decision-making that follows handovers and failure of communication of information to patients and their caretakers. Consequently, duty handovers were perceived inadequate. They were described as gaps in the continuity of care, and contributed to poor quality of care, birth trauma and mothers’ dissatisfaction with the childbirth experience.ConclusionThe handover process and practices should be standardized using protocols and checklists. Health workers need training on handover practices, team work and communication skills (so as to improve patient-health provider and provider-provider interaction.

Aging Patients

Experience with my mother over the past 3 years led me reflect on how we care for older adults. For those who do not have a nurse in the family to provide care coordination and oversight, how are the gaps in continuity of care and transitions in care addressed? Many specialized positions are emerging for nurses in care coordination. These positions tend to focus on the most complex patients and on selected transitions in care. There are pockets of excellence but nurses who provide direct care in inpatient and outpatient settings are the safety net for older adults like my mother. They need competencies in assessment of older adults and awareness of how illness may present differently in this population. They need to be aware of the entire continuum of care and provide care coordination for patients who are not receiving specialized care coordination services.

Shared Care For Hematologic Malignancy Survivors: Challenges Between Primary Care Physicians and Hematologist/Oncologists

BackgroundMany cancer patients are cured, or have a series of remissions interspersed with periods of re-treatment. In 2006, the Institute of Medicine's From Cancer Patient to Cancer Survivor: Lost in Transition recommended comprehensive treatment summaries and follow-up care plans for all cancer survivors. [Parry 2013] There were about 14 million cancer survivors in the US as of January 2012; this population is expected to be 18 million by 2022. [Siegel 2012] Among survivors, 64% have survived 5 years or more; 40% have survived 10 years or more; and 15% have survived 20 years or more after diagnosis. [de Moor 2013] Many survivors in this growing population experience physical, psychological, and/or financial long-term/ late effects. The complexities of managing cancer survivors suggest their care should not be conceived as a transition from the hematologist/oncologist to the primary care provider, but rather as an ongoing, flexible collaboration determined by individual survivor needs. MethodsPolling surveys were conducted within the 2012 online education activity Sharing Care for Survivors of Hematologic Malignancies, developed by The Leukemia & Lymphoma Society and Medscape Oncology. Case-based education was delivered by an expert panel of hematologist/oncologists (Hem/Oncs) and primary care physicians (PCPs) to illustrate effective communication methods and critical communication points between (Hem/Oncs) and (PCPs). ResultsAs of June 30, 116 Hem/Oncs and 171 PCPs overall responded to the polling surveys, which address current practices and barriers in shared care of cancer survivors. Responses were analyzed to identify gaps in continuity of care among specialties. A summary of responses shows the most significant barrier in effective management is the lack of survivorship care plans and treatment summaries (41% Hem/Oncs vs 51% PCPs). Only 8% and 5% of Hem/Oncs and PCPs, respectively, use survivorship care plans, although both Hem/Oncs and PCPs agreed that such plans and summaries are the most useful communication vehicle among professionals (73% Hem/Oncs vs 67% PCPs). PCPs used patient self-reported data more frequently to document cancer treatment, compared with Hem/Oncs (21% vs 7%, respectively); Hem/Oncs used caregiver reports more often than did PCPs (12% vs 3%, respectively). Similar numbers of Hem/Oncs and PCPs estimated that PCPs spend more than 4 hours of non-reimbursed time weekly researching issues related to patient care (47% Hem/Oncs vs 41% PCPs). Despite progress in electronic health records and widespread Internet access, these physicians most typically use the phone to communicate about the management of cancer survivors (64% Hem/Oncs vs 74% PCPs), followed by faxed/mailed letters, with email ranking as least used. Lack of prompt communication between Hem/Oncs and PCPs was the second highest barrier listed by respondents to effective management (22% and 27%, respectively). ConclusionAnalysis of the Hem/Onc and PCP learner responses to the polling surveys point to clinical complexities and persistent challenges in the co-management of survivors of hematologic cancers. The challenges relate to communication, technological, healthcare system and healthcare coverage issues.Timely, ongoing communication of the right clinical information between Hem/Oncs and PCPs is essential for optimal management of the growing number of cancer survivors. Hem/Oncs and PCPs devote significant time each week to addressing the cancer survivors' needs; the lack of reimbursed time for PCPs may be an impediment to optimal care. Hem/Oncs and PCPs place a high value on the utility of survivorship care plans; however, they are not widely used. Phone calls are the current preferred communication mode. Until other technological solutions are more widely used to share clinical information, it is important to employ practical solutions, such as providing PCPs with information to help prioritize cancer survivors' follow-up care needs and providing patients/caregivers with brief cancer treatment summaries. Communication strategies to address potentially preventable causes of death, such as cardiac disease and second cancers, as well as acknowledgment and treatment for anxiety and depression related issues [Harrington 2010], which often accompany the uncertainty many cancer survivors live with, are critical. Disclosures:No relevant conflicts of interest to declare.

Nurse Retention in a Correctional Facility

Retention of nursing staff is more complex in a correctional facility. After a period of 3 years, only 20% of the staff remained employed at this study facility. Without retention of qualified correctional nurses, there are decreases in access to care, gaps in continuity of care, and less time for mentorship. Trained correctional nurses improve patient and staff safety, provide more education, and are more team-oriented. The purpose of this study was to identify barriers and benefits to nursing staff satisfaction with their job and the likelihood that they will continue to work in correctional settings. Practice and patient care will be favorably impacted if correctional nurses are provided with services such as new hire orientation, clinical ladder programs to recruit and retain nursing staff, and teambuilding.

Perspectives Among Primary Care Providers and Hematologist/Oncologists in the Coordination of Care for Patients with Hematologic Malignancies

Abstract 3156 IntroductionClinicians have different expectations and perceptions regarding the role of primary care providers (PCPs) and hematologist/ oncologists (Hem/Oncs) in the provision of follow-up and survivorship care for patients with hematologic malignancies, and for the cancer survivor in general [Cheung JCO 2009]. The continuing decline in the number of specialists will require PCP involvement in the care of the patients with hematologic malignancies in particular, as well as cancer survivors in general. An outcomes study investigated barriers to shared care/ co-management of patients with hematologic malignancies and current practices of PCPs and Hem/Oncs regarding communication, provider roles and responsibilities and resources needed to implement effective cancer survivorship care plans. Methods:Internet polling surveys within an educational activity developed by the Leukemia & Lymphoma Society (LLS) and Medscape LLC with outcomes assessment by CE Outcomes, LLC. The activity learning objectives centered on roles and communication touch points for PCPs and Hem/Oncs, strategies and tools for optimal patient care, and recommendations for care of survivors with hematologic malignancies. Case-based education was delivered by an expert panel of hematologist/oncologist and primary-care physicians to illustrate critical communication points between Hem/Onc and PCP. The activity addressed regional variations in care, fragmentation of care, and helped define healthcare provider roles in the shared–care model. Electronic health records (EHR) and a treatment summary form were discussed as methods for effectively communicating a survivorship care plan among healthcare providers.More than 4, 000 physicians participated in the activity; 170 specialists and 587 PCPs were respondents to the survey. Polling questions and outcomes survey addressed barriers and current practices in shared care of patients with hematologic malignancies. Responses of PCPs and Hem/Oncs were aggregated and compared to identify gaps in continuity of care between specialties. Results:A summary of interactivity responses of PCPs (N=587) and Hem/Oncs (N=170) shows the most significant barrier to co-management of patients with hematologic malignancies was “lack of defined roles and responsibilities for PCPs vs specialists” (51.5% Hem/Onc vs 53.2% PCP). Confusion over roles is evident as 55.6% of Hem/Onc respondents expect the oncology specialist to follow the patient during the “watch and wait' period, while 45.8% of PCPs expect the PCP to follow the patient, and 35.4% expect the PCP and specialist to follow the patient together. More than half of PCPs and specialists report that they should co-manage follow up for cancer recurrence. The majority of PCPs and specialists report that standardized communication tools are from “very to extremely important” yet only approximately one third of PCPs and specialists are currently using EHR resources, with a third in the process of implementing EHR in their practices. Conclusions:Barriers to the provision of shared care and co-management of the cancer survivor can be addressed by more clearly defining individual clinician roles and responsibilities. Bridging gaps in the survivorship care plan requires improved communication between Hem/Oncs and PCPs to coordinate “watch and wait” care and follow-up screening, and effective methods to transfer patient records and history including Treatment Summary Forms and EHR. Disclosures:No relevant conflicts of interest to declare.