Health Care Modalities Research Articles

Increase in Video Consultations During the COVID-19 Pandemic: Healthcare Professionals' Perceptions about Their Implementation and Adequate Management.

In response to the COVID-19 pandemic, health care modalities such as video consultations have been rapidly developed to provide safe health care and to minimize the risk of spread. The purpose of our study is to explore Spanish healthcare professionals’ perceptions about the implementation of video consultations. Based on the testimonies of 53 professionals, different categories emerged related to the four identified themes: benefits of video consultations (for professionals, patients, and the health system, and compared to phone calls), negative aspects (inherent to new technologies and the risk of a perceived distancing from the professional), difficulties associated with the implementation of video consultations (technological difficulties, lack of technical skills and refusal to use video consultation among professionals and patients), and the need for training (technological, nontechnical, and social-emotional skills, and adaptation of technical skills). Additionally, the interviewees indicated that this new modality of health care may be extended to a broader variety of patients and clinical settings. Therefore, since video consultations are becoming more widespread, it would be advisable for health policies and systems to support this modality of health care, promoting their implementation and guaranteeing their operability, equal access and quality.

Emerging issues in the ethical utilization of pediatric extracorporeal membrane oxygenation

As we have refined our extracorporeal membrane oxygenation (ECMO) capabilities and enhanced our ability to care for children with illnesses previously deemed lethal, the patient populations for whom ECMO is a medically appropriate intervention have expanded. Such expansion has prompted consideration of evolving ethical issues. In this review, we highlight several of the emerging ethical issues in pediatric ECMO. Expansion of ECMO into increasingly diverse pediatric populations has prompted several ethical questions. First, some have found that there are specific clinical settings in which ECMO ought to be obligatory. Second, expanded use of ECMO may prompt disagreements among healthcare providers or between providers and family members regarding decisions about decannulation. Finally, analysis of the ethical challenges associated with integration of other disruptive healthcare modalities into patient care, will allow us insight into how to assure ethical expansion of pediatric ECMO. Expansion of pediatric ECMO highlights several ethical issues including whether ECMO is ever ethically obligatory, how to ethically decannulate a patient when survival is deemed unlikely, and how to guide expansion of pediatric ECMO based upon lessons learned from the implementation of other disruptive healthcare interventions into practice.

Differences in Results and Related Factors Between Hospital-at-Home Modalities in Catalonia: A Cross-Sectional Study.

Hospital-at-home (HaH) is a healthcare modality that provides active treatment by healthcare staff in the patient’s home for a condition that would otherwise require hospitalization. The aims were to describe the characteristics of different types of hospital-at-home (HaH), assess their results, and examine which factors could be related to these results. A cross-sectional study based on data from all 2014 HaH contacts from Catalonia was designed. The following HaH modalities were considered—admission avoidance (n = 7214; 75.1%) and early assisted discharge (n = 2387; 24.9%). The main outcome indicators were readmission, mortality, and length of stay (days). Multivariable models were fitted to assess the association between explanatory factors and outcomes. Hospital admission avoidance is a scheme in which, instead of being admitted to acute care hospitals, patients are directly treated in their own homes. Early assisted discharge is a scheme in which hospital in-care patients continue their treatment at home. In the hospital avoidance modality, there were 8.3% readmissions, 0.9% mortality, and a mean length of stay (SD) of 9.6 (10.6) days. In the early assisted discharge modality, these figures were 7.9%, 0.5%, and 9.8 (11.1), respectively. In both modalities, readmission and mean length of stay were related to comorbidity and type of hospital, and mortality with age. The results of HaH in Catalonia are similar to those observed in other contexts. The factors related to these results identified might help to improve the effectiveness and efficiency of the different HaH modalities.

Conceptual model for pluralistic healthcare behaviour: results from a qualitative study in southwestern Uganda

IntroductionMedical pluralism, or concurrent utilisation of multiple therapeutic modalities, is common in various international contexts, and has been characterised as a factor contributing to poor health outcomes in low-resource settings....

Home visits in primary care: Differences among professional categories and health macro-regions.

Home visit is a modality of health care that is expanding in Brazil and in the world. Public and private services have invested in the implementation of this type of assistance. It happens due to its potential to transform the model of care, highlighting the work quality of the primary health care teams. To analyze house call rates in primary care in the Brazilian public healthcare system according to professional categories and health macro-regions in the state of Minas Gerais, southeast region of Brazil. An ecological study that used as the information source the production data from the Primary Care Information System (2010 to 2015). House call rates (per 3000 inhabitants) by primary care professionals constituted the response variable. The independent variables were professional categories and the 13 health macro-regions of the state. The data were analyzed using the Mann-Whitney test. A total of 26,932,463 house calls were performed in the period, but the number of visits in 2015 was significantly lower compared to 2010. Significantly higher house call rates were found for some professional categories (mid-level professionals and nurses) and significant differences were found among the macro-regions (P < 0.05). The profile of house calls by primary care professionals revealed the constant presence of this care modality, but the distribution of these visits is uneven among the different professional categories and macro-regions of the state.

A mindfulness and compassion-based program applied to pregnant women and their partners to decrease depression symptoms during pregnancy and postpartum: study protocol for a randomized controlled trial

BackgroundPregnancy and the postpartum period are times of great change for women and their partners, often bringing substantial challenges and stress. Approximately 10%–20% of women suffer from mood disorders such as depression in the perinatal period. There are risks involved in using psychopharmacological interventions to treat perinatal depression. Mindfulness and compassion-based educational programs could be efficacious and cost-effective options for the prevention and treatment of perinatal mood disorders. The aim of this study is to assess the efficacy of an adapted Mindfulness-Based Childbirth and Parenting (MBCP) program that includes compassion training for pregnant women in primary care (PC) settings in the Spanish National Health System to decrease perinatal depression.MethodsA multicenter randomized controlled trial (RCT) will be conducted. Participants will be pregnant women (n = 122) and their partners who wish to participate. They will be enrolled and assessed in PC settings and randomly assigned to either: (1) an adapted MBCP educational program tailored to the Spanish National Health System + treatment as usual (TAU); or (2) TAU only. The main outcome to be assessed will be depression, evaluated with the Edinburgh Postnatal Depression Scale (EPDS). Secondary outcomes will include self-reported measures of perceived stress, affects, mindfulness, self-compassion, maternal self-efficacy, and use of health and social services. Patients will be assessed at four timepoints: baseline; post-treatment; and at three and six months after childbirth. Intention-to-treat and per-protocol analyses will be carried out using linear regression mixed models. Effect sizes will be estimated using Cohen’s d.DiscussionPerinatal depression is a significant health problem. An effective and low-cost childbirth education program that incorporates mindfulness and compassion practices may be a beneficial preventive complementary healthcare modality for expectant women and their partners. This study will be the first multicenter RCT in Spanish PC settings using adapted MBCP and compassion practices to reduce symptoms of depression during pregnancy and the postpartum period.Trial registrationClinicalTrials.gov, NCT03247491. Registered on 31 July 2017.

Prevalence, and health- and sociodemographic associations for visits to traditional and complementary medical providers in the seventh survey of the Troms\xf8 study

BackgroundPatient-centered culturally sensitive health care (PC-CSHC) has emerged as a primary approach to health care. This care focuses on the cultural diversity of the patients rather than the views of the health care professionals. PC-CSHC enables the patient to feel comfortable, respected, and trusted in the health care delivery process. As users of traditional and complementary medicine (T&CM) rarely inform their conventional health care providers of such use, the providers need to identify the users of T&CM themselves to avoid negative interaction with conventional medicine and to be able to provide them with PC-CSHC. Since the patterns of traditional medicine (TM) use are different to those of complementary medicine (CM), the aim of this study was to investigate the prevalence, and the health- and sociodemographic associations for visits to TM- and CM providers in an urban population.MethodThe data were collected through two self-administrated questionnaires from the seventh survey of the Tromsø Study, a population-based cohort study conducted in 2015–2016. All inhabitants of Tromsø aged 40 or above were invited (n = 32,591) and n = 21,083 accepted the invitation (response rate 65%). Pearson chi-square tests and one-way ANOVA tests were used to describe differences between the groups whereas binary logistic regressions were used for adjusted values.ResultsThe results revealed that 2.5% of the participants had seen a TM provider, 8.5% had seen a CM provider whereas 1% had visited both a TM and a CM provider during a 12-month period. TM users tended to be older, claim that religion was more important to them, have poorer economy and health, and have lower education compared to CM users. We found that more than 90% of the participants visiting T&CM providers also used conventional medicine.ConclusionA considerable number of the participants in this study employed parallel health care modalities including visits to conventional, traditional, and complementary medicine providers. To offer patient-centered culturally sensitive health care that is tailored to the patients’ treatment philosophy and spiritual needs, conventional health care providers need knowledge about, and respect for their patients’ use of parallel health care systems.

Integrated Health Care and Counseling Psychology: An Introduction to the Major Contribution

Integrated health care is playing an increasingly important role in the U.S. health care system by improving coordination of care and reducing health disparities and cost. Despite its promise, the field of counseling psychology has been slow in responding to this trend and in preparing its future workforce for this health care modality. In a series of articles, in this Major Contribution we highlight (a) the rise and benefits of integrated health care; (b) two counseling psychology programs’ training models and assessment methods for preparing their students for careers in integrated health care; and (c) the experiences, satisfaction, and challenges of counseling psychologists working in integrated health care settings.

Homozygous familial hypercholesterolaemia in childhood – The first case report in Southeast Europe

Homozygous familial hypercholesterolaemia (HoFH) is the rare, severe, but treatable disease characterised by exceedingly high levels of low-density lipoprotein cholesterol (LDL-C) and subsequent premature coronary heart disease. Of note, HoFH detection rate and patient access to healthcare and treatment modalities still differ considerably across EU countries. To our current knowledge, there are still no published reports describing HoFH in the paediatric population of Southeastern Europe.In this case report, a few important topics on obstacles in getting adequate health care service and management of HoFH children from Southeastern Europe are tackled.

Percursos e obstáculos na Rede de Atenção à Saúde: trajetórias assistenciais de mulheres em região de saúde do Nordeste brasileiro

The article aims to assess organization and access to the Healthcare Network in a health region, from the perspective of female users. Healthcare trajectories were constructed for women with high-grade cervical squamous intraepithelial lesions, covered by different modalities of primary health care (PHC) in urban and rural areas, in municipalities in the interior, and in the capital city of the Northeast health region, Brazil. Women used PHC as their regular service for prevention and care, but reported barriers to access to medical appointments, especially in rural areas. Positive assessments were associated with positive reception by the health service and representation of the basic health unit or family health unit as the available locus for care. A perception of low case-resolution capacity in PHC was associated with delays in scheduling referrals, irregular/insufficient supply of medicines, and physician turnover. Women reported difficulty in access to specialized care, especially in municipalities in the interior, with the use of public and private services. All the users in the capital city of the health region underwent confirmatory diagnostic tests and surgeries in the Brazilian Unified National Health System (SUS). Support from family members, friends, and local politicians were part of the healthcare trajectories. Interprofessional communication was nearly non-existent and health professional-patient communication was precarious. The regionalized network appeared disconnected and with confusing flows in terms of guaranteeing timely access for users in municipalities in the interior and with additional difficulties for those in rural areas, even in the capital city, revealing incompleteness in regional arrangements and persistence of inter- and intra-municipal inequalities in access.

French Therapeutic Education Programme Aimed at Improving the Quality of Life of Laryngectomised Patients and their Close Relations: the Three Stages (Observational and Interventional Randomised) of the Study "PETAL".

The therapeutic education of patients and their close relations is, as yet, poorly developed in France in the field of oncology. Total laryngectomy is a mutilating surgical procedure having a major impact on the patient's life, due to its physical and functional sequelae. Its psychosocial consequences are also important and alter the quality of life of patients and their close relations. Currently, care for laryngectomised patients consists essentially in informing and educating them on some technical procedures during hospital admission. The intervention of a speech therapist, often serves as the link between the patient and the hospital care team. These healthcare modalities often insufficiently account for the social, environmental and personal factors that interact in health-related problems. This report presents the therapeutic education programme protocol "PETAL" for laryngectomised patients and their close relations to improve their quality of life. The trial will be conducted over three phases: (1) the "pilot" phase aims at developing knowledge on the consequences of laryngectomy on the quality of life of patients and their close relations and developed a pluridisciplinary therapeutic education program, (2) the prospective intervention "replication" phase aims at evaluating the programme's transferability in three centres and (3) the cluster-randomised multicentric comparative intervention phase, will assess the benefits of the developed programme. Phase I identified nine themes of workshops related to therapeutic education, training and coordination of care. The developed programme should reinforce town-hospital links to improve help, follow-up and support for patients and their close relations.

Use of Telehealth to Increase Breastfeeding Exclusivity and Duration

Telehealth is a rapidly growing healthcare modality that can be utilized to deliver breastfeeding education and support to increase breastfeeding outcomes including exclusivity and duration. The purpose of this integrative review is to explore and evaluate the strength of the current research evidence supporting the effectiveness of telehealth to deliver breastfeeding education and support. The review was conducted using five electronic databases to search English language articles related to telehealth and breastfeeding from 2009 to 2016. Eleven studies were identified as meeting the inclusion criteria, and included a total of 4,896 participants in five countries. Results from the review suggest that telehealth is a promising modality for breastfeeding education and support and is perceived as an acceptable and beneficial delivery method. More research is needed to determine which specific modalities are most effective and how they are best implemented.

Attitudes and self-reported practices of New Zealand osteopaths to exercise consultation

BackgroundExercise-based interventions are commonly utilised within many healthcare modalities, although their role in New Zealand (NZ) osteopathy is unclear. ObjectivesInvestigate osteopaths' attitudes and practices of exercise consultation, in the context of general health and wellbeing (GH) and specific medical conditions (SMC); and identify factors associated with these practices and attitudes. MethodsCross-sectional survey of NZ practicing osteopaths. ResultsResponse rate was 38% (n = 125/332). Degree of positive attitude towards advice for GH, 75 ± 9% (mean ± SD), and prescription for SMC, 73 ± 6%, were similar. The most commonly reported exercise consultation provided was advice for SMC (75 ± 24%), followed by advice for GH (63 ± 30%), prescription for SMC (63 ± 30%) and for GH (52 ± 32%). Practices of exercise consultation were associated with positive attitudes (p < 0.05 for all) and osteopathic training institution with attitudes towards exercise prescription (p = 0.03). Level of academic qualification was associated with practice of advice for SMC (p < 0.001) and osteopathic practice style with practice of prescription for SMC (p = 0.03). Increased personal exercise duration was weakly predictive of positive attitudes towards exercise advice (r2 = 0.04 for regression model) and associated with practice of advice for GH (p = 0.01). Common forms of exercise delivery by osteopaths included verbal instruction (87%), physical demonstration by the practitioner (73%), or by the patient (62%). ConclusionsThese data suggest most respondents hold positive attitudes towards exercise consultation and incorporate exercise within their clinical practice. Whereas training and practice style appear more closely associated with therapeutic exercise, personal exercise behaviours appear to be more closely associated with exercise advice for general health and wellbeing.

‘Hope givers’? A scoping review of new media and mental health in 27 Australian Christian organisations

ABSTRACTThis article explains a range of conceptual and methodological innovations in the use of new media for the clinical practice and public communication of mental health. Building on two current contexts – the emerging research area of new media and mental health, and major reform of the mental health system in Australia – this article presents a scoping review of the online communication of Christian organisations that offer mental health care in Australia. This article compares the websites of 27 Australian Christian mental health organisations, analysing these organisations’ configurations of mainstream and religious modalities of mental health care, their discursive and visual communication strategies, as well as their use of social media platforms.

A Review on Traditionally Used Medicinal Plants/Herbs for Cancer Therapy in Ethiopia: Current Status, Challenge and Future Perspectives

Cancer is a disease which occurs when changes in a group of normal cells within the body lead to uncontrolled growth causing a lump called a tumor; this is true of all cancers except leukemia (cancer of the blood). If left untreated, it leads to death by invading and destroying normal cells. Ethiopia is one of the developing countries which are seriously affected by cancer due to lack of awareness and inaccessible to modern medicine on time. To reduce the severity of this serious problem, about 80% of the population still relay on the traditional medicine as a primary health care modality throughout the country. Even though many plants/herbs have been used by traditional healers of Ethiopian society, many species still await to have scientific evidence of their anticancer activity. The aim of this review is to collect available data about the cancer therapy of medicinal plants/herbs so far studied by ethnobotanical surveys and scientific study in Ethiopia country. It reviews on traditional medicinal plant used by traditional healers within communities of different regional state in Ethiopia country. Out of 65 plants/herbs reviewed in this study, only 30 plants/herbs have been scientifically studied by different researchers at different times for its medicinal value/pharmacological activity against different types of cancer diseases at in vitro stage. The rest still needs further investigation to confirm its biological activity for cancer therapy. In general, this review shows the therapeutic potential of many traditional medicinal plants/herbs that can be used in future to treat varies type of diseases including cancer.

Optimization of Medical Supply Chains and Forward Store Locations for Recurrent Homecare Patient Demand with Periodic Interruptions

Robust and cost-effective distribution is critical to any home delivery network growing company, both to meet demand under normal conditions and to adapt to temporary disruptions. Home healthcare is anticipated to be a rapidly growing modality of healthcare, itself the largest industry in the US and rife with optimization needs in areas such as logistics, scheduling, and supply chains. We develop two mixed integer programming models to optimize forward storage locations in the supply chain of a national consumable medical supplies company with consistent monthly repeating demand, temporary disruption of facility operations, and remote international manufacturers. Modified p-median single and multi-echelon models are used to determine optimal locations of warehouses and distribution facilities that minimize total transportation cost, with 13% savings in one application (approximately $1.4 million annually). Sensitivity analyses to a range of scenarios suggest that the optimal solution is robust across a number of potential scenarios.

Recent advances in the prevention of preterm birth.

Preterm birth (PTB) remains a major obstetric healthcare problem and a significant contributor to perinatal morbidity, mortality, and long-term disability. Over the past few decades, the perinatal outcomes of preterm neonates have improved markedly through research and advances in neonatal care, whereas rates of spontaneous PTB have essentially remained static. However, research into causal pathways and new diagnostic and treatment modalities is now bearing fruit and translational initiatives are beginning to impact upon PTB rates. Successful PTB prevention requires a multifaceted approach, combining public health and educational programs, lifestyle modification, access to/optimisation of obstetric healthcare, effective prediction and diagnostic modalities, and the application of effective, targeted interventions. Progress has been made in some of these areas, although there remain areas of controversy and uncertainty. Attention is now being directed to areas where greater gains can be achieved. In this mini-review, we will briefly and selectively review a range of PTB prevention strategies and initiatives where progress has been made and where exciting opportunities await exploitation, evaluation, and implementation.

Participatory action inquiry using baccalaureate nursing students: The inclusion of integrative health care modalities in nursing core curriculum.

Nurses, nursing educators and students support the inclusion of integrative health care (IHC) into nursing core curriculum as a way to create nurses who deliver nursing care to the full extent of their scope of practice and advance evidenced based IHC. Because of the holistic nature of IHC modalities, research to investigate appropriate teaching strategies and potential efficacy of learning IHC in the baccalaureate core curriculum requires a holistic approach. Therefore a phenomenological exploration using participatory action inquiry was conducted at a large Midwestern university. Eighteen first year nursing students were selected as co-researchers. Their experiences in learning and delivering three 15min IHC interventions (foot reflexology, lavender aromatherapy and mindful breathing) in an acute care setting were captured using reflexive journaling and participation in structured and organic communicative spaces. Of the patients approached, 67% accepted to receive one or more IHC modalities (147/219). Using van Manen's model for holistic data reduction three themes emerged: The experience of presence, competency and unexpected results. Learning IHC modalities is best supported by a self-reflective process that is constructed and modeled by a nurse faculty member with experience in delivering IHC modalities.

Evidence based practice within the complementary medicine context

Evidence based practice (EBP) is a system of applying the most current and valid high quality evidence to support clinical decision making in a healthcare setting. In the twenty five years since its inception, EBP has become the accepted benchmark for excellence in healthcare. Although the system emerged within the biomedical sciences, in the years since EBP has become normative across all healthcare modalities from dentistry, allied health to complementary and alternative medicine (CAM). Practicing evidence based medicine within any modality potentially offers the patient the best available care based on high quality evidence. Yet it is the nature of the evidence that provokes some questions about the suitability of EBP across all modalities of healthcare. The meta analysis of randomized controlled trial (RCT) stands at the pinnacle of the hierarchy of evidence in EBP. This forms a challenge to CAM due to the difficulty in reducing the elementals of a holistic naturopathic assessment of a patient into an answerable question to be tested within a RCT. On one level this makes EBP paradigmatically incompatible with CAM, yet on another level it presents the opportunity to redefine the parameters of what is considered high level evidence. EBP has become a tool, and at times a weapon wielded by governments and health insurance companies to direct healthcare funding and policy. The implications of the nature of accepted evidence are becoming far reaching. The pursuit of the best available healthcare for each individual is the focus of EBP. However, the injudicious use of this system to direct health policy is fraught with biomedical bias and dominance. This issue raises the challenge to CAM to present high level evidence according to the rules of evidence, or face the annihilation of centuries of empirical knowledge.

Synchronous telehealth for outpatient allergy consultations: A 2-year regional experience

BackgroundTelehealth continues to advance as a health care modality; however, reported experience for synchronous TeleAllergy is limited. ObjectiveTo determine the percentage of new and follow-up visits conducted via TeleAllergy in a hospital-based clinic. MethodsA retrospective study evaluating the first 2 years of a synchronous patient-to-allergist TeleAllergy platform. ResultsA total of 112 synchronous TeleAllergy encounters were conducted from January 2014 through December 2015; 66 (59%) of these were new consultations. The mean (SD) age was 26.9 (15.3) years, and 54% of the participants were female. Food allergy (30%), allergic rhinitis (20%), and urticaria (16%) represented the top 3 consultation reasons. Sixteen of 66 patients (24.2%) and 3 of 46 patients (6.5%) attending new and follow-up TeleAllergy visits, respectively, were recommended for an in-person appointment (P = .02). No difference was found between new and follow-up TeleAllergy visits regarding subsequent telephone communication (41% vs 26%, P = .11) or prescriptions ordered (50% vs 33%, P = .08). New TeleAllergy visits were more likely to have more than 1 laboratory test ordered (45% vs 17%, P = .002). On the basis of patient location, the 112 TeleAllergy visits resulted in an estimated savings of 200 workdays or schooldays, US$58,000 in travel-related costs, and 80,000 kilometers not driven. ConclusionBoth new and follow-up visits to the allergist/immunologist were well received by patients and demonstrated significant indirect cost savings, with less than one fourth of the patients recommended for an in-person visit. This appears to be the first systematic assessment of TeleAllergy for new and follow-up patient encounters in a clinic-based allergy/immunology practice.